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Treatment Response to JAK Inhibitors in Long-standing Alopecia Areata (≥8 Years): A Real-world Observational Study

Xinchen Ke1, Yixia Gao1, Jundong Huang1

  • 1Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.

Acta Dermato-Venereologica
|June 30, 2026
PubMed

Insights

Janus kinase (JAK) inhibitors show limited efficacy for long-standing alopecia areata. However, a subset of patients experienced meaningful hair regrowth, suggesting JAK inhibitors may still be a viable treatment option.

Area of Science:

  • Dermatology
  • Immunology
  • Pharmacology

Background:

  • Long-standing alopecia areata (≥8 years) presents a therapeutic challenge.
  • Robust evidence for Janus kinase (JAK) inhibitors in this subgroup is lacking.

Purpose of the Study:

  • To evaluate the efficacy and safety of baricitinib, tofacitinib, or ritlecitinib in patients with long-standing alopecia areata.
  • To assess treatment response and adverse events in this patient population.

Main Methods:

  • Retrospective, single-centre study of 31 patients with alopecia areata episodes lasting ≥8 years.
  • Patients treated with baricitinib, tofacitinib, or ritlecitinib between February 2021 and December 2025.
  • Efficacy assessed by absolute and relative Severity of Alopecia Tool (SALT) scores at week 24.

Main Results:

  • Mean baseline SALT score was 62.8; 64.5% had SALT ≥50.
  • At week 24, 27.6% achieved SALT ≤20 and 24.1% achieved SALT ≤10.
  • 48.3% achieved ≥30% hair regrowth (SALT30), with 24.1% achieving SALT80.
  • Treatment discontinuation was high (58.1%), mainly due to lack of efficacy.
  • Most common adverse events included folliculitis (22.6%) and acne (12.9%).

Conclusions:

  • JAK inhibitors demonstrate limited overall therapeutic response in long-standing alopecia areata.
  • A subset of patients achieves clinically meaningful hair regrowth.
  • JAK inhibitors represent a viable, albeit limited, treatment option for select patients with severe, persistent alopecia areata.

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