The Relative Efficacy and Safety of Monotherapies for Alopecia Areata: A Network Meta-Analysis Study.

BACKGROUND

Scant evidence exists for the relative efficacy of therapies for alopecia areata (AA)-including those approved by the Food and Drug Administration, namely, baricitinib, deuruxolitinib, and ritlecitinib.

AIMS: We determined the relative efficacy and safety of monotherapy with janus kinase inhibitors (JAKIs), apremilast, and dupilumab.

METHODS

Following a systematic review, we conducted Bayesian network meta-analysis (NMAs) that produced Surface Under the Cumulative RAnking (SUCRA) values and point estimates for pairwise relative effects; we also performed sensitivity analyses.

RESULTS

In total, regimens with eight various JAKIs were compared, namely, ruxolitinib, ATI-501, baricitinib, brepocitinib, deuruxolitinib, ivarmacitinib, ritlecitinib, and tofacitinib. Our analyses ranked "deuruxolitinib 12 mg twice daily for 24 weeks," the most efficacious insofar as "proportion of participants achieving SALT ≤ 20 at 24 weeks" (SALT20) (SUCRA = 92.6%), and "proportion of participants achieving SALT ≤ 10 at 24 weeks" (SALT10) (SUCRA = 97.7%). As per SALT20, the highest-ranked regimen was more efficacious than "baricitinib 2 mg once daily for 24 weeks" (odds ratio [OR] = 5.37, 95% credible interval [CI] = 1.59, 13.70, p < 0.05). Furthermore, the efficacy of the FDA-approved JAKIs exhibited a dose-dependent relationship; for instance, baricitinib 4 mg once daily for 24 weeks was more efficacious than "baricitinib 2 mg once daily for 24 weeks" in terms of SALT20 (OR = 2.25, 95% CI = 1.56, 3.21, p < 0.05). Results from our sensitivity analyses support that our base analyses were robust.

CONCLUSIONS

We produced high-quality evidence on the comparative effectiveness of monotherapies for AA with various regimens of 8 JAKIs, including the FDA-approved ones. Our findings can improve clinicians' decision-making and update guidelines for medical practice.