Efficacy of Janus Kinase Inhibitors in Alopecia in Jordanian Patients: A Retrospective Cohort Study

Abstract

Introduction Alopecia areata (AA) is an autoimmune disorder causing non-scarring hair loss on the scalp, eyebrows, eyelashes, and other areas. Janus kinase (JAK) inhibitors have emerged as promising treatments, but data on their efficacy in Middle Eastern populations, including Jordanians, are limited. The Severity of Alopecia Tool (SALT) score is commonly used to assess disease severity, while Clinician-Reported Outcome (ClinRO) measures provide additional insights. Aim To evaluate the efficacy of JAK inhibitors in Jordanian AA patients using the SALT score as the primary outcome measure. Methods A retrospective cohort study was conducted at King Hussein Hospital, Jordanian Royal Medical Services, from January 2020 to December 2023. Medical records of AA patients aged ≥18 years treated with JAK inhibitors were reviewed. Data included demographics, disease duration, previous treatments, and adverse effects. Efficacy was assessed by the percentage change in SALT scores at six and 12 months. Statistical analyses included repeated-measures MANCOVA (Multivariate Analysis of Covariance), Chi-square, and independent t-test. A p-value <0.05 was considered significant. Results Our analysis included 57 patients, of which 31 (54.4%) received tofacitinib and 26 (45.6%) received baricitinib. A significantly higher proportion of baricitinib users had treatment durations >12 months (53.8%) compared to tofacitinib users (12.9%), while shorter durations (three to six months) were more common among tofacitinib users (41.9% vs. 15.4%; p = 0.003). Baricitinib users showed greater improvement in SALT scores between six to 12 months (92.77% vs. 82.93%; p = 0.030, partial η² = 0.084), with a trend toward greater total improvement at 12 months (96.64% vs. 93.11%; p = 0.055, partial η² = 0.067). Although not statistically significant, baricitinib showed numerically higher ClinRO improvement in eyebrows from six to 12 months (84.58% vs. 70.29%; p = 0.212) and in eyelashes (83.92% vs. 73.40%; p = 0.313), suggesting better late-stage response compared to tofacitinib. Conclusion JAK inhibitors demonstrated efficacy in Jordanian patients with alopecia areata, leading to enhanced SALT scores and noticeable hair regrowth, with baricitinib demonstrating greater improvement in SALT scores compared to tofacitinib.

Keywords: alopecia areata; baricitini; janus kinase inhibitors; salt score; tofacitinibb.

Figure 1. Percentage of SALT score improvement.

JAK: Janus kinase, SALT: Severity of Alopecia Tool.

Figure 2. Percentage of CLinRO eyebrows score improvement.

JAK: Janus kinase, ClinRO: Clinician-Reported Outcome.

Figure 3. Percentage of CLinRO eyelashes score improvement.

JAK: Janus kinase, ClinRO: Clinician-Reported Outcome.