TOPLINE:

In a study, nearly half of patients with severe alopecia areata (AA) achieved clinically meaningful hair regrowth after switching to a second JAKi, with higher odds among those who had responded to prior therapy.

METHODOLOGY:

• Researchers conducted a multicenter retrospective study of 108 patients (mean age, 38.5 years; 66.7% female; 66.7% White and 7.4% Black) with severe AA treated with an oral JAKi for at least 6 months before switching from October 2024 to January 2025.
• The mean duration of AA was 12.1 years.
• Treatment response was assessed using the Severity of Alopecia Tool (SALT) score at baseline, before switching, and after subsequent therapies.
• Outcomes included clinically meaningful hair regrowth defined as a SALT score ≤ 20, identification of predictors of response to a second JAKi, and adverse events.

TAKEAWAY:

• Overall, 66.6% of patients showed “any improvement” with first-line JAKi therapy, 35.8% achieved SALT ≤ 20, and 27.4% achieved SALT ≤ 10.
• Overall, 48.8% of patients achieved a SALT score ≤ 20 after switching to a second JAKi, and 32.6% achieved SALT ≤ 10. Most patients initially treated with tofacitinib switched to a second JAKi due to an inadequate response (58%) or insurance denial (26%).
• Among 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 significantly more likely to respond after switching to a second inhibitor (odds ratio, 3.33; P = .022).
• Adverse events were generally mild, with no unexpected adverse events. Common events included acne, hyperlipidemia, mild infections, and laboratory abnormalities that were resolved without the need for dose de-escalation.

IN PRACTICE:

“Our findings support the clinical utility of JAKi switching in select patients with refractory AA, particularly those with a history of response to a prior oral JAKi treatment,” the authors of the study wrote, noting that “prior response may help guide treatment decisions.” Large-scale prospective studies, they added, “are needed to clarify optimal sequencing strategies, understand mechanisms of variable response, and identify predictors that can inform personalized care.”

SOURCE:

The study was led by Aubrey Martin, BS, Department of Dermatology, Lahey Hospital & Medical Center, Burlington, and Li-Chi Chen, MD, MPH, Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, and was published online on January 30 in the Journal of the American Academy of Dermatology.

LIMITATIONS:

The study was limited by its retrospective design, lack of standardized switching criteria, underrepresentation of longer-term treatment responses, and relatively small sample size to detect more nuanced differences in treatment response.

DISCLOSURES:

The study was supported by a student internship award from the National Alopecia Areata Foundation. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.