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A recent meta-review determined that Janus kinase inhibitors, including baricitinib and deuruxolitinib, may be effective for treating alopecia areata, with treatment response being determined by dosage.

Cytokines implicated in the pathogenesis of alopecia areata (AA) function via activating Janus kinase signaling pathways, which induces phosphorylation of signal transducer molecules and activates transcription (STAT) molecules. The involvement of the JAK/STAT signaling pathway in AA and the hair cycle implicates the role of JAK inhibitors in treating AA. This systematic review and meta-analysis concluded that JAK inhibitors, including baricitinib and deuruxolitinib may be useful in treating AA and produce a therapeutic response in a dose-dependent pattern. The study findings are published in the journal Acta Dermato-Venereologica.

Baricitinib and Deuruxolitinib Treatment Were Superior to Other Treatments for AA

The study results indicated that AA treatment with a 4 mg once daily dose of baricitinib and a 12 mg twice daily dose of deuruxolitinib are superior to other AA treatments regardless of the description of AA, as both resulted in either a Severity of Alopecia Tool (SATL) score of  ≥ 50% or ≥ 50% loss of scalp hair. There was a dose–response relationship between treatment with deuruxolitinib and baricitinib and therapeutic effect in AA patients.

Treatment Response Associated With Definition Criteria of AA

In the given study, two meta-analyses were conducted based on the outcome measures. Baricitinib was more effective when AA was referred to as ≥ 50% loss of scalp hair whereas deuruxolitinib was more effective when AA was referred to as SALT score of ≥ 50%.

Adverse Effects of Oral JAK Inhibitors

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The common adverse effects of oral JAK inhibitors include urinary tract infections, acne, headache, upper respiratory infections, and laboratory abnormalities, which comprise increased blood creatine phosphokinase, cytopenias, and lipid abnormalities. Oral JAK inhibitors are not associated with new malignancies or the reactivation of tuberculosis.

JAK Inhibitor Treatment in Various SALT Criteria

Concerning improvement in alopecia from the baseline, this meta-analysis evaluated the therapeutic efficacy of different JAK inhibitors for SALT30, SALT50, SALT75, SALT90, and SALT100. Regarding SALT30, the therapeutic response of brepocitinib was superior to treatment with ritlecitinib. Concerning SALT50, SALT75, and SALT90, treatment with baricitinib (4 mg once daily) was superior to ritlecitinib and brepocitinib. Regarding SALT100, baricitinib was found superior to brepocitinib in the treatment of AA. When AA was defined as severe by a SALT score of ≥ 50%, deuruxolitinib( 12 mg twice daily) was found superior to baricitinib in SALT50, SALT75, and SALT90.

This study concluded that AA patients derive benefits from JAK inhibitors, including a 4 mg once daily dose of baricitinib and a 12 mg twice daily dose of deuruxolitinib, which can be associated with mild side effects in these patients.

Source:

Barati Sedeh, F., Michaelsdóttir, T. E., Henning, M. A. S., Jemec, G. B. E., & Ibler, K. S. (2023). Comparative Efficacy and Safety of Janus Kinase Inhibitors Used in Alopecia Areata: A Systematic Review and Meta-analysis. Acta Derm Venereol, 103, adv00855. https://doi.org/10.2340/actadv.v103.4536