Switching between Janus kinase inhibitors for treatment of alopecia areata: A multicenter retrospective review

Abstract

Background Janus kinase inhibitors (JAKis) have transformed the treatment of alopecia areata (AA), but not all patients respond to initial therapy. The utility of switching between JAKis in treatment-refractory AA remains underexplored. Objective To evaluate the efficacy and safety of switching between JAKis in patients with severe AA. Methods In this multicenter retrospective study, we analyzed 108 patients with severe AA who switched between oral JAKis after a minimum treatment duration of 6 months. Treatment response was assessed using the Severity of Alopecia Tool (SALT). Multivariable logistic regression was used to identify predictors of response to a second JAKi. Results Overall, 48.8% of patients achieved SALT ≤20 on their second JAKi, and 32.6% achieved SALT ≤10. Of 21 patients who received a third JAKi, 52.4% achieved SALT ≤20 and 38.1% achieved SALT ≤10. Patients who responded to their first JAKi were more likely to respond to a second (odds ratio, 3.33; 95% CI, 1.22-9.68; P = .022). Adverse events were mild and consistent with prior reports. Limitations Retrospective design, treatment heterogeneity, and potential selection bias. Conclusions Switching between JAKis appears to be a viable strategy for severe AA patients, especially those responding to prior JAKi. Prior response may help guide treatment sequencing.