Comparative Efficacy and Safety of Janus Kinase Inhibitors Used in Alopecia Areata: A Systematic Review and Meta-analysis

The aim of this study was to compare the efficacy and safety of treatment with Janus kinase inhibitors for alopecia areata, measured by change in Severity of Alopecia Tool (SALT) score. A systematic review fol-lowing Preferred Reporting Items for Systematic Re-views and Meta-analyses (PRISMA) guidelines was performed using Medline, EMBASE and Cochrane libra-ry. All studies investigating the efficacy of treatments for alopecia areata were included. Primary outcomes were the proportion of patients with alopecia areata achieving 30%, 50%, 75%, 90% and 100% improve-ment in SALT score after treatment with a Janus kina-se inhibitor. A meta-analysis was performed including all randomized controlled trials investigating Janus kinase inhibitors. A total of 37 studies matched the in-clusion criteria and were included. Meta-analysis was performed based on 5 randomized studies. Regarding patients with alopecia areata defined as >= 50% scalp hair loss, baricitinib 4 mg once daily demonstrated the highest efficacy. However, among patients with alope-cia areata defined as a SALT score >= 50, oral deurux-olitinib 12 mg twice daily demonstrated the highest efficacy. Deuruxolitinib and baricitinib appear to be promising drugs for the treatment of alopecia areata. However, the response depends on the dosage of the drug. More randomized trials, with identical inclusion criteria and dose and duration of treatment, are requi-red to confirm these findings.