{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T23:55:35Z","timestamp":1792108535633,"version":"4.4.0"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:00:00Z","timestamp":1771286400000},"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:p>Alopecia areata (AA) is a chronic, immune-mediated hair loss disorder, in which the JAK-STAT signaling pathway plays an important pathogenic role. Available agents for AA include minoxidil, corticosteroids, immunosuppressants and Janus kinase (JAK) inhibitors, among others. For adults with severe AA, JAK inhibitors have emerged as cornerstone systemic treatments, but the responses to them are variable. Ivarmacitinib is a novel and highly selective JAK1 inhibitor, which has been approved for AA in China recently with little real-world evidence. We present a case of a patient with severe AA who achieved significant improvement with ivarmacitinib after suboptimal response to tofacitinib, and review previous studies on switching therapy between different JAK inhibitors for AA. This case suggests that ivarmacitinib is a viable alternative for tofacitinib-refractory AA, possibly due to its higher JAK1 selectivity. Further studies are required to define ivarmacitinib\u2019s optimal position in AA treatment algorithm, and to elucidate underlying mechanisms behind JAK inhibitors, which is essential for more personalized and targeted therapy for severe AA.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1766847","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T06:34:34Z","timestamp":1771310074000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Significant improvement with ivarmacitinib after suboptimal response to tofacitinib in severe alopecia areata: a case report and literature review"],"prefix":"10.3389","volume":"17","author":[{"given":"Zulin","family":"Wan","sequence":"first","affiliation":[{"name":"Graduate School, Beijing University of Chinese Medicine","place":["Beijing, China"]},{"name":"Department of Dermatology, China-Japan Friendship Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Dermatology, China-Japan Friendship Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dingquan","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Dermatology, China-Japan Friendship Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1007\/s12016-021-08883-0","article-title":"Alopecia areata: an update on etiopathogenesis, diagnosis, and management","volume":"61","author":"Zhou","year":"2021","journal-title":"Clin Rev Allergy Immunol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.4274\/balkanmedj.galenos.2025.2024-9-31","article-title":"Baricitinib for the treatment of moderate-to-severe alopecia areata","volume":"42","author":"Gencebay","year":"2025","journal-title":"Balkan Med J"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2025.09.044","article-title":"Ivarmacitinib for the treatment of adults with severe alopecia areata: Results from a phase 3 trial","volume":"94","author":"Zhou","year":"2026","journal-title":"J Am Acad Dermatol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e70182","DOI":"10.1002\/mco2.70182","article-title":"Alopecia areata: pathogenesis, diagnosis, and therapies","volume":"6","author":"Ma","year":"2025","journal-title":"MedComm"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2023.1253795","article-title":"Case report: Dupilumab therapy for alopecia areata in a 4-year-old patient resistant to baricitinib","volume":"10","author":"Cai","year":"2023","journal-title":"Front Med"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2023.1287139","article-title":"Screening for latent infectious disease in patients with alopecia areata before initiating JAK inhibitors therapy: a single-center real-world retrospective study","volume":"10","author":"Huang","year":"2023","journal-title":"Front Med"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1007\/s40265-025-02202-z","article-title":"Ivarmacitinib sulfate: first approval","volume":"85","author":"Keam","year":"2025","journal-title":"Drugs"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.4103\/idoj.idoj_452_22","article-title":"Which is the ideal JAK inhibitor for alopecia areata - baricitinib, tofacitinib, ritlecitinib or ifidancitinib - revisiting the immunomechanisms of the JAK pathway","volume":"14","author":"Sardana","year":"2023","journal-title":"Indian Dermatol Online J"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.3390\/ijms262110337","article-title":"JAK2 46\/1 (GGCC) haplotype in oncogenesis, as risk stratifier, and indicator for drug resistance in myeloproliferative neoplasms","volume":"26","author":"Perrone","year":"2025","journal-title":"Int J Mol Sci"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1038\/s41375-025-02737-w","article-title":"Germline Jak2-R1063H mutation interferes with normal hematopoietic development and increases risk of thrombosis and leukemic transformation","volume":"39","author":"Zimolova","year":"2025","journal-title":"Leukemia"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e142205","DOI":"10.1172\/jci.insight.142205","article-title":"Selective inhibition of JAK3 signaling is sufficient to reverse alopecia areata","volume":"6","author":"Dai","year":"2021","journal-title":"JCI Insight"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1111\/jocd.13966","article-title":"Experience with oral tofacitinib in severe alopecia areata with different clinical responses","volume":"20","author":"Dincer Rota","year":"2021","journal-title":"J Cosmet Dermatol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"e15062","DOI":"10.1111\/dth.15062","article-title":"Less is more? 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