Baricitinib, Ritlecitinib, and Deuruxolitinib Demonstrate Efficacy in Severe AA
Key Takeaways
Baricitinib, ritlecitinib, and deuruxolitinib are currently the only FDA–approved systemic therapies for severe alopecia areata (AA).
Phase 3 clinical trials show higher rates of scalp hair regrowth (measured via improved SALT scores) with these agents compared with placebo.
Long-term treatment is often necessary to maintain regrowth, as discontinuation is associated with relapse and JAK inhibitors carry monitoring requirements due to potential adverse effects.
An analysis of clinical trials reports that Janus kinase (JAK) inhibitors shows significant efficacy and manageable safety profiles in treating severe alopecia areata (AA).
Alopecia areata (AA) is an autoimmune disorder characterized by nonscarring hair loss that can affect the scalp, face, and body and carries significant psychosocial burden. The condition affects approximately 2% of the global population and is associated with autoimmune, atopic, and psychiatric comorbidities that may worsen quality of life.
The authors noted recent therapeutic advances in AA treatment have focused on JAK inhibitors, and in particular targeting inflammatory signaling pathways implicated in AA pathogenesis. Three JAK inhibitors are currently approved in the United States for severe AA: baricitinib, ritlecitinib, and deuruxolitinib. Clinical trials evaluating these agents, the authors noted, have shown clinically meaningful improvements in scalp hair regrowth compared with placebo. In the BRAVE-AA1 and BRAVE-AA2 trials, significantly more patients receiving baricitinib achieved SALT scores ≤20 at week 36, indicating ≤20% scalp hair loss.
Similarly, data from the ALLEGRO trial indicated ritlecitinib 50 mg daily significantly increased the proportion of patients achieving SALT ≤20 at week 24, with responses continuing to improve through week 48. Deuruxolitinib demonstrated comparable efficacy in THRIVE-AA. Patients receiving 8 mg twice daily achieved significantly greater rates of SALT ≤20 vs. placebo at week 24.
Most adverse events were mild to moderate, although boxed warnings include risks such as serious infections, malignancy, cardiovascular events, and thrombosis.
"JAKis are effective treatments for patients with severe AA, which causes patchy hair loss and a significant psychosocial burden for patients," the authors wrote. "Depending on the disease severity and AA episode duration, patients may experience variable responses to JAKis and will likely require long-term treatment to prevent relapse, which may increase the risk of experiencing a rare but serious AE. However, data from Phase 3 studies of baricitinib, ritlecitinib, and deuruxolitinib demonstrate that treatment for 24 or 36 weeks improves not only hair regrowth but also QoL; thus, JAKis are beneficial treatments for patients with severe AA."
Source: DiRuggiero D, Kuchera K. Journal of Drugs in Dermatology. 2026;25(3):204