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. 2022 Aug 24:13:950450.
doi: 10.3389/fphar.2022.950450. eCollection 2022.

The efficacy and safety of JAK inhibitors for alopecia areata: A systematic review and meta-analysis of prospective studies

Diqin Yan  1   2 , Huaying Fan  3 , Min Chen  1   2 , Lin Xia  1   4 , Simin Wang  1   4 , Wenliang Dong  1   2 , Qian Wang  1 , Suping Niu  3 , Huiying Rao  5 , Liming Chen  1 , Xiaoyan Nie  2 , Yi Fang  1
Affiliations

The efficacy and safety of JAK inhibitors for alopecia areata: A systematic review and meta-analysis of prospective studies

Diqin Yan et al. Front Pharmacol. .

Abstract

Background: Due to the lack of comprehensive evidence based on prospective studies, the efficacy and safety of Janus Kinase (JAK) inhibitors (including tofacitinib, ruxolitinib, baricitinib, ritlecitinib and brepocitinib) for alopecia areata (AA) are yet to be proved. Methods: The systematic review and meta-analysis was performed pursuant to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline and registered on PROSPERO (CRD42022303007). Results: Fourteen prospective studies (5 RCTs and 9 non-RCTs), enrolling a total of 1845 patients with AA, were included for quantitative analysis. In RCTs, oral JAK inhibitors resulted in higher good response rate compared with control (RR: 6.86, 95% CI: 2.91-16.16); topical JAK inhibitors did not show any difference compared with control (RR: 1.00, 95% CI: 0.31-3.18). In non-RCTs, the pooled rate of good response to oral, topical and sublingual JAK inhibitors were 63% (95% CI: 44%-80%), 28% (95% CI: 1%-72%) and 11% (95% CI: 1%-29%), respectively. The pooled recurrence rate in patients treated with JAK inhibitors was 54% (95% CI: 39%-69%), mainly due to the withdrawal of JAK inhibitors. In RCTs, no difference was found in the risk of experiencing most kind of adverse events; in non-RCTs, the reported adverse events with high incidence rate were mostly mild and manageable. Conclusion: JAK inhibitors are efficacious and generally well-tolerated in treating AA with oral administration, whereas topical or sublingual administration lacks efficacy. Subgroup analyses indicate that baricitinib, ritlecitinib and brepocitinib seem to have equal efficacy for AA in RCTs; ruxolitinib (vs. tofacitinib) and AA (vs. AT/AU) are associated with better efficacy outcomes in non-RCT. Due to the high recurrence rate after withdrawal of JAK inhibitors, continuous treatment should be considered to maintain efficacy. Systematic Review Registration: PROSPERO: CRD 42022303007.

Keywords: JAK inhibitors; alopecia areata; baricitinib; janus kinase inhibitors; meta-analysis; ruxolitinib; systematic review; tofacitinib.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA flow diagram of record selection process.
FIGURE 2
FIGURE 2
Forest plot of the pooled rate of good response to JAK inhibitors in patients with AA based on (A) RCTs and (B) non-RCTs.
FIGURE 3
FIGURE 3
Forest plot of the pooled rate of complete response to JAK inhibitors in patients with AA based on (A) RCTs and (B) non-RCTs.
FIGURE 4
FIGURE 4
Forest plot of the percent change from baseline in SALT score in patients taking JAK inhibitors for AA based on (A) RCTs and (B) non-RCTs.
FIGURE 5
FIGURE 5
Forest plot of recurrence rate in patients treated with JAK inhibitors based on non-RCTs.
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