Comparative efficacy of Janus kinase inhibitors in severe alopecia areata: a network meta-analysis based on randomized controlled trials.

BACKGROUND

Alopecia areata (AA), an autoimmune disorder, represents a prevalent form of hair loss among individuals. Various therapeutic approaches exist for managing AA, with Janus kinase (JAK) inhibitors emerging as a promising treatment modality. Nonetheless, there is a paucity of rigorous studies directly comparing the efficacy of JAK inhibitors in cases of severe AA.

OBJECTIVE

Evaluating the efficacy of different JAK inhibitors in the treatment of severe AA.

METHOD: A comprehensive search was conducted across four databases-PubMed, Embase, Web of Science, and Cochrane Library-on February 10, 2025. Eligible studies were selected based on the PICOS framework. A Bayesian network meta-analysis was employed to extract and analyze data concerning the number of individuals achieving SALT20 and corresponding sample sizes. The relative efficacy of the interventions was evaluated using league tables and Surface Under the Cumulative Ranking values.

RESULT: A total of 3866 patients with AA were included in the study, with a total of 10 interventions. Of these, the one that showed the best efficacy was deuruxolitinib_12 mg, but with wider 95% confidence intervals. Of all the JAK inhibitors, the one with significant efficacy and high precision of results was baricitinib_4 mg (OR: 2.59, 95% CI: 1.98-3.38).

CONCLUSION

The efficacy of JAK inhibitors in the treatment of severe AA is definitive, and all possess a dose-dependent effect. This study provides valuable insights for clinicians in selecting appropriate pharmacological interventions for severe AA. Key messages What is already known on this topic: Alopecia areata is an autoimmune disorder characterized by patchy hair loss on the scalp. Previous studies have demonstrated that JAK inhibitors can effectively treat alopecia areata, but research comparing the efficacy of different JAK inhibitors is lacking. What this study adds: This study established a ranking of efficacy for different JAK inhibitors in treating severe alopecia areata, providing a reference for selecting clinical treatment regimens. How this study might affect research, practice, or policy: Future studies are needed to directly compare the efficacy of different JAK inhibitors in treating alopecia areata. This will provide more reliable evidence for formulating treatment regimens for alopecia areata.