{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,11]],"date-time":"2026-11-11T06:02:35Z","timestamp":1794376955792,"version":"4.9.0"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,4,17]],"date-time":"2023-04-17T00:00:00Z","timestamp":1681689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fimmu.2023.1152513","type":"journal-article","created":{"date-parts":[[2023,4,17]],"date-time":"2023-04-17T05:58:11Z","timestamp":1681711091000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":40,"title":["Efficacy and safety of different JAK inhibitors in the treatment of alopecia areata: a network meta-analysis"],"prefix":"10.3389","volume":"14","author":[{"given":"Dongfan","family":"Wei","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuqing","family":"Shen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiuzu","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,4,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1111\/1346-8138.16207","article-title":"Alopecia areata: current understanding of the pathophysiology and update on therapeutic approaches, featuring the Japanese dermatological association guidelines","volume":"49","author":"Fukuyama","year":"2022","journal-title":"J Dermatol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3238\/arztebl.2016.0377","article-title":"The diagnosis and treatment of hair and scalp diseases","volume":"113","author":"Wolff","year":"2016","journal-title":"Dtsch Arztebl Int"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jaad.2017.04.1141","article-title":"Alopecia areata: disease characteristics, clinical evaluation, and new perspectives on pathogenesis","volume":"78","author":"Strazzulla","year":"2018","journal-title":"J Am Acad Dermatol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2017.09.011","article-title":"Alopecia areata is a medical disease","volume":"78","author":"Korta","year":"2018","journal-title":"J Am Acad Dermatol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1038\/s41392-021-00791-1","article-title":"The JAK\/STAT signaling pathway: from bench to clinic","volume":"6","author":"Hu","year":"2021","journal-title":"Signal Transduct Target Ther"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2021.08.010","article-title":"The role for JAK inhibitors in the treatment of immune-mediated rheumatic and related conditions","volume":"148","author":"Fragoulis","year":"2021","journal-title":"J Allergy Clin Immunol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1007\/s00403-017-1777-5","article-title":"Efficacy of topical tofacitinib in promoting hair growth in non-scarring alopecia: possible mechanism via VEGF induction","volume":"309","author":"Meephansan","year":"2017","journal-title":"Arch Dermatol Res"},{"key":"B8","doi-asserted-by":"publisher","first-page":"5462633","DOI":"10.1155\/2021\/5462633","article-title":"Pharmacological effects of centella asiatica on skin diseases: evidence and possible mechanisms","volume":"2021","author":"Park","year":"2021","journal-title":"Evid Based Complement Alternat Med"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-010-9491-z","article-title":"Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses","volume":"25","author":"Stang","year":"2010","journal-title":"Eur J Epidemiol."},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.2147\/CLEP.S66677","article-title":"Quality assessment of observational studies in a drug-safety systematic review, comparison of two tools: the Newcastle-Ottawa scale and the RTI item bank","volume":"6","author":"Margulis","year":"2014","journal-title":"Clin Epidemiol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1186\/s12874-015-0060-8","article-title":"Ranking treatments in frequentist network meta-analysis works without resampling methods","volume":"15","author":"Rucker","year":"2015","journal-title":"BMC Med Res Methodol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2022.891434","article-title":"Oral tofacitinib and systemic corticosteroids, alone or in combination, in patients with moderate-to-Severe alopecia areata: a retrospective study","volume":"9","author":"Zhang","year":"2022","journal-title":"Front Med (Lausanne)."},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.2340\/00015555-3057","article-title":"Comparison of the treatment outcome of oral tofacitinib with other conventional therapies in refractory alopecia totalis and universalis: a retrospective study","volume":"99","author":"Shin","year":"2019","journal-title":"Acta Derm Venereol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1111\/ijd.15657","article-title":"Sublingual tofacitinib for alopecia areata: a roll-over pilot clinical trial and analysis of pharmacokinetics","volume":"60","author":"Lai","year":"2021","journal-title":"Int J Dermatol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1159\/000494613","article-title":"Janus kinase inhibitors for the treatment of severe alopecia areata: an open-label comparative study","volume":"235","author":"Almutairi","year":"2019","journal-title":"Dermatology."},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2019.10.016","article-title":"Ruxolitinib cream for the treatment of patients with alopecia areata: a 2-part, double-blind, randomized, vehicle-controlled phase 2 study","volume":"82","author":"Olsen","year":"2020","journal-title":"J Am Acad Dermatol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2021.05.050","article-title":"Efficacy and safety of the oral janus kinase inhibitor baricitinib in the treatment of adults with alopecia areata: phase 2 results from a randomized controlled study","volume":"85","author":"King","year":"2021","journal-title":"J Am Acad Dermatol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2110343","article-title":"Two phase 3 trials of baricitinib for alopecia areata","volume":"386","author":"King","year":"2022","journal-title":"N Engl J Med"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2022.03.045","article-title":"Phase 2 randomized, dose-ranging trial of CTP-543, a selective janus kinase inhibitor, in moderate-to-severe alopecia areata","volume":"87","author":"King","year":"2022","journal-title":"J Am Acad Dermatol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1103442","article-title":"Alopecia areata","volume":"366","author":"Gilhar","year":"2012","journal-title":"N Engl J Med"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1038\/nm.3645","article-title":"Alopecia areata is driven by cytotoxic T lymphocytes and is reversed by JAK inhibition","volume":"20","author":"Xing","year":"2014","journal-title":"Nat Med"},{"key":"B22","doi-asserted-by":"publisher","first-page":"e1500973","DOI":"10.1126\/sciadv.1500973","article-title":"Pharmacologic inhibition of JAK-STAT signaling promotes hair growth","volume":"1","author":"Harel","year":"2015","journal-title":"Sci Adv"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1111\/ijd.14192","article-title":"Treatment of alopecia universalis with topical janus kinase inhibitors - a double blind, placebo, and active controlled pilot study","volume":"57","author":"Bokhari","year":"2018","journal-title":"Int J Dermatol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1038\/nature09114","article-title":"Genome-wide association study in alopecia areata implicates both innate and adaptive immunity","volume":"466","author":"Petukhova","year":"2010","journal-title":"Nature."},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1586\/1744666X.2015.1085306","article-title":"The role of lymphocytes in the development and treatment of alopecia areata","volume":"11","author":"Guo","year":"2015","journal-title":"Expert Rev Clin Immunol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.3390\/ijms22052618","article-title":"Immunological properties of atopic dermatitis-associated alopecia areata","volume":"22","author":"Kageyama","year":"2021","journal-title":"Int J Mol Sci"},{"key":"B27","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1111\/all.15071","article-title":"Phase 2a randomized clinical trial of dupilumab (anti-IL-4Ralpha) for alopecia areata patients","volume":"77","author":"Guttman-Yassky","year":"2022","journal-title":"Allergy."},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1007\/s13555-021-00512-0","article-title":"Patient perspectives of the social, emotional and functional impact of alopecia areata: a systematic literature review","volume":"11","author":"Mostaghimi","year":"2021","journal-title":"Dermatol Ther (Heidelb)."},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.18921","article-title":"Exploring the overlap between alopecia areata and major depressive disorder: epidemiological and genetic perspectives","author":"Foo","year":"2023","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"B30","article-title":"A phase 2a randomized, placebo-controlled study to evaluate the efficacy and safety of the oral janus kinase inhibitors ritlecitinib and brepocitinib in alopecia areata: 24-week results","volume":"85","author":"King","year":"2021","journal-title":"J Am Acad Dermatol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2021.10.036","article-title":"Ritlecitinib and brepocitinib demonstrate significant improvement in scalp alopecia areata biomarkers","volume":"149","author":"Guttman-Yassky","year":"2022","journal-title":"J Allergy Clin Immunol"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1002\/art.40841","article-title":"Cardiovascular safety during treatment with baricitinib in rheumatoid arthritis","volume":"71","author":"Taylor","year":"2019","journal-title":"Arthritis Rheumatol"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.25259\/IJDVL_975_19","article-title":"Treatment outcome of oral tofacitinib and ruxolitinib in patients with alopecia areata: a systematic review and meta-analysis","volume":"87","author":"Yu","year":"2021","journal-title":"Indian J Dermatol Venereol Leprol."},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2022.950450","article-title":"The efficacy and safety of JAK inhibitors for alopecia areata: a systematic review and meta-analysis of prospective studies","volume":"13","author":"Yan","year":"2022","journal-title":"Front Pharmacol"},{"key":"B35","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1038\/nrrheum.2017.23","article-title":"The emerging safety profile of JAK inhibitors in rheumatic disease","volume":"13","author":"Winthrop","year":"2017","journal-title":"Nat Rev Rheumatol"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2023.1152513\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,17]],"date-time":"2023-04-17T05:58:14Z","timestamp":1681711094000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2023.1152513\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,17]]},"references-count":35,"alternative-id":["10.3389\/fimmu.2023.1152513"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2023.1152513","relation":{"has-part":[{"id-type":"doi","id":"https:\/\/doi.org\/10.3389\/fimmu.2023.1152513.s001","asserted-by":"subject"}]},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,17]]},"article-number":"1152513"}}