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. 2023 Apr 17:14:1152513.
doi: 10.3389/fimmu.2023.1152513. eCollection 2023.

Efficacy and safety of different JAK inhibitors in the treatment of alopecia areata: a network meta-analysis

Dongfan Wei  1 , Yi Chen  2 , Yuqing Shen  2 , Bo Xie  3 , Xiuzu Song  3
Affiliations

Efficacy and safety of different JAK inhibitors in the treatment of alopecia areata: a network meta-analysis

Dongfan Wei et al. Front Immunol. .

Abstract

Background: Alopecia areata (AA) is an immune disease characterized by non-scarring hair loss. With the widespread application of JAK inhibitors in immune-related diseases, attention is being given to their role in the treatment of AA. However, it is unclear which JAK inhibitors have a satisfactory or positive effect on AA. This network meta-analysis aimed to compare the efficacy and safety of different JAK inhibitors in the treatment of AA.

Methods: The network meta-analysis was performed according to the PRISMA guidelines. We included randomized controlled trials as well as a small number of cohort studies. The differences in efficacy and safety between the treatment and control groups were compared.

Results: Five randomized controlled trials, two retrospective studies, and two prospective studies involving 1689 patients were included in this network meta-analysis. In terms of efficacy, oral baricitinib and ruxolitinib significantly improved the response rate of patients compared to placebo [MD = 8.44, 95% CI (3.63, 19.63)] and [MD = 6.94, 95% CI, (1.72, 28.05)],respectively. Oral baricitinib treatment significantly improved the response rate compared to non-oral JAK inhibitor treatment [MD=7.56, 95% CI (1.32,43.36)]. Oral baricitinib, tofacitinib, and ruxolitinib treatments significantly improved the complete response rate compared to placebo [MD = 12.21, 95% CI (3.41, 43.79)], [MD = 10.16, 95% CI (1.02, 101.54)], and [MD = 9.79, 95% CI, (1.29, 74.27)], respectively. In terms of safety, oral baricitinib, tofacitinib, and ruxolitinib treatments significantly reduced treatment-emergent adverse event rates compared with conventional steroid treatment [MD = 0.08, 95% CI (0.02, 0.42)], [MD = 0.14, 95% CI (0.04, 0.55)], and [MD = 0.35, 95% CI, (0.14, 0.88)], respectively.

Conclusion: Oral baricitinib and ruxolitinib are excellent options for the treatment of AA owing to their good efficacy and safety profiles. In contrast, non-oral JAK inhibitors do not appear to have satisfactory efficacy in treating AA. However, further studies are required to verify the optimal dose of JAK inhibitors for AA therapy.

Keywords: JAK inhibitors; alopecia areata; baricitinib; network meta-analysis; ruxolitinib; 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
Flow diagram.
Figure 2
Figure 2
Risk of bias in (A) included RCTs and (B) included non-RTCs.
Figure 3
Figure 3
Network diagrams of outcome indicators. (A) good response rate; (B) complete response rate; (C) percent change form baseline in SALT scorer; (D) TEAE (treatment emergent adverse events) rate. A: placebo treatment B: conventional steroid therapy C: any dose of oral tofacitinib treatment D: any dose of oral baricitinib treatment E: any dose of oral ruxolitinib treatment F: nonoral JAK inhibitor treatment.
Figure 4
Figure 4
Funnel plot of outcome indicators. (A) good response rate; (B) complete response rate; (C) percent change from baseline in SALT score; (D) TEAE (treatment emergent adverse events) rate. A: placebo treatment B: conventional steroid therapy C: any dose of oral tofacitinib treatment D: any dose of oral baricitinib treatment E: any dose of oral ruxolitinib treatment F: nonoral JAK inihibitor treatment.
Figure 5
Figure 5
Pairwise comparison forest graph of outcome indicators. (A) good response rate; (B) complete response rate; (C) percent change from baseline in SALT score; (D) TEAE (treatment emergent adverse events) rate. A: placebo treatment B: conventional steroid therapy C: any dose of oral tofocitinib treatment D: any dose of oral baricitinib treatment E: any dose of oral ruxolitinib treatment : nonoral JAK inihibitor treatment.
Figure 6
Figure 6
Curve diagram of SUCRA of outcome indicators. (A) good response rate; (B) complete response rate; (C) percent change from baseline in SALT score; (D) TEAE (treatment emergent adverse events) rate. A: placebo treatment B: conventional steroid therapy C: any dose of oral tofacitinib treatment D: any dose of oral baricitinib treatment E: any dose of oral ruxolitinib treatment F: nonoral JAK inhibitor treatment.
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