Switching between JAK inhibitors a feasible solution for severe alopecia areata

Patients with treatment-refractory alopecia areata (AA) may benefit from switching between Janus kinase inhibitors (JAKis), suggests a study.

“JAKis have transformed the treatment of AA, but not all patients respond to initial therapy,” the researchers said. “The utility of switching between JAKis in treatment-refractory AA remains underexplored.”

To address this, a multicentre retrospective study was conducted including 108 patients with severe AA who switched between oral JAKis after a minimum treatment duration of 6 months. The research team assessed treatment response using the Severity of Alopecia Tool (SALT). They also identified predictors of response to a second JAKi using multivariable logistic regression.

Nearly half of the patients (48.8 percent) achieved SALT ≤20 on their second JAKi, and about a third (32.6 percent) achieved SALT ≤10. Twenty-one patients with AA received a third JAKi, of which more than half (52.4 percent) achieved SALT ≤20, while more than one in three (38.1 percent) achieved SALT ≤10.

Notably, AA patients who responded to their first JAKi had a greater chance of also responding to a second JAKi (odds ratio, 3.33, 95 percent confidence interval, 1.22‒9.68; p=0.022).

In terms of safety, adverse events were mostly mild in severity and similar to previous reports.

“Switching between JAKis appears to be a viable strategy for severe AA patients, especially those responding to prior JAKi,” the researchers said. “Prior response may help guide treatment sequencing.”

The study was limited by its retrospective design, treatment heterogeneity, and potential selection bias.