Upadacitinib for Alopecia: Current Evidence and Clinical Insights

Upadacitinib, a selective Janus kinase (JAK) 1 inhibitor, has demonstrated promising efficacy in alopecia areata (AA), particularly in patients unresponsive to conventional therapies. As JAK inhibitors gain prominence, understanding upadacitinib's role in AA management is critical.

This scoping review synthesizes data from 24 publications, including 64 AA patients treated with upadacitinib (15-45 mg daily). Most patients experience substantial or complete hair regrowth within 1-4 months. The most common AA subtypes include alopecia universalis (n = 28), ophiasis (n = 15), and alopecia totalis (n = 8). Upadacitinib was generally well tolerated, with mild adverse events such as transient acneiform eruptions, leukopenia, and creatine phosphokinase elevations. Many patients with comorbid autoimmune conditions, such as atopic dermatitis (59.4%) and inflammatory bowel disease, also reported improvement. Despite these promising findings, limitations include small cohort sizes, variability in prior treatments, and reliance on case reports. Two ongoing studies are underway: a US Phase 3 clinical trial (M23-716) assessing long-term efficacy and safety, and a real-world observational study in China (NCT06573593) comparing upadacitinib with other JAK inhibitors. These studies underscore the need for larger, controlled trials to establish standardized treatment protocols and long-term safety outcomes.

(i) Upadacitinib demonstrates good efficacy in treating AA. (ii) Its safety profile supports potential off-label use. (iii) Larger studies are essential to validate current findings and optimize management.