[Efficiency and safety of JAK inhibitors for alopecia totalis and alopecia universalis].

Objective: To evaluate the efficacy and safety of the Janus kinase (JAK) inhibitors ritlecitinib and baricitinib in the treatment of alopecia totalis and alopecia universalis. Methods: The clinical data of alopecia totalis and alopecia universalis patients with a Severity of Alopecia Tool (SALT) score≥95 who received baricitinib or ritlecitinib therapy in the Department of Dermatology, Xiangya Hospital, Central South University from December 2022 to April 2025 were retrospectively analyzed. Assessment was performed at baseline and at weeks 12, 24, and 36 post-treatment using the SALT, Eyebrow Assessment (EBA), and Eyelash Assessment (ELA). Safety was evaluated based on adverse events observed during the treatment period. The primary efficacy endpoint was the proportion of patients achieving a SALT score of≤20 after treatment. The secondary efficacy endpoints included the eyebrow response rate and the eyelash response rate. Results: A total of 30 patients were enrolled, comprising 12 males and 18 females, with a median age of 16.5 years (IQR 13.0, 27.0). Among them, 90.0% (27/30) had alopecia totalis, 86.7% (26/30) had eyebrow involvement, and 60.0% (18/30) had eyelash involvement. Twenty-two patients were treated with ritlecitinib, while 8 received baricitinib. The median SALT scores at baseline, week 12, and week 24 were 100.0 (IQR 98.0, 100.0) score, 76.5 (IQR 53.0, 100.0) score, and 28.0 (IQR 4.3, 91.3) score, respectively. Efficacy analysis revealed that at week 12, the SALT response rates were 3/22 for ritlecitinib and 2/8 for baricitinib. At week 24, the response rates were 12/22 for ritlecitinib and 2/8 for baricitinib. Additionally, at week 12, the overall eyebrow and eyelash response rates were 7/19 and 7/12, respectively. At week 24, these rates were 13/19 for eyebrows and 9/12 for eyelashes. A total of 15 adverse events were reported, all of which were mild to moderate, with folliculitis (9/15) being the most common. Conclusion: Baricitinib and ritlecitinib are both effective and well-tolerated in treating alopecia totalis and universalis, demonstrating a manageable safety profile.