New and Upcoming Breakthroughs in Alopecia Areata Treatment

Maddy

2 weeks ago

New and Upcoming Breakthroughs in Alopecia Areata Treatment

Janus kinase (JAK) inhibitors are oral medications that interfere with an overactive immune pathway called JAK-STAT, which normally helps regulate inflammation throughout the body. In alopecia areata, this pathway becomes dysregulated, causing your immune system to mistakenly attack hair follicles. By blocking JAK signaling, these drugs break that feedback loop, allowing hair to regrow.

“The JAK-STAT pathway acts like an on-switch for the immune system. When we block it, we prevent the immune system from recruiting more inflammatory cells to attack the hair,” says Mostaghimi.

Right now, there are three FDA-approved JAK inhibitors to treat moderate-to-severe alopecia areata:

Baricitinib (Olumiant)

In June 2022, the FDA approved baricitinib as the first systemic treatment for adults with severe alopecia areata. The once-daily oral medication works by blocking JAK1 and JAK2 proteins, which play roles in causing inflammation.

In pivotal trials, about 1 in 3 people taking baricitinib had hair regrowth covering 80 percent or more of their scalp after 36 weeks of treatment. After two years on the drug, 90 percent of people had hair regrowth on 80 percent or more of their scalp.

Baricitinib had already been approved for rheumatoid arthritis and atopic dermatitis, which means doctors had long-term safety data even before its alopecia indication.

“It’s a well-studied medication — if a patient or clinician is concerned about long-term risks, baricitinib has the most-established safety record of the three,” says Mostaghimi.

Ritlecitinib (Litfulo)

The oral JAK inhibitor ritlecitinib received FDA approval in June 2023. It’s taken once daily and is approved for adults and adolescents ages 12 and older with severe alopecia areata.

In one of the pivotal trials used for the drug’s approval, researchers found that after 24 weeks, people who took ritlecitinib had significant hair regrowth compared with people who took a placebo (an inactive pill). Between 14 percent and 31 percent of patients in the different treatment groups reached the study endpoint, which was 20 percent or less scalp hair loss.

This medication targets proteins called JAK3 and TEC kinases, a slightly different way of working that may influence the side effects it can cause. “It may have less impact on cholesterol than some other JAK inhibitors,” says Mostaghimi.

Ritlecitinib is the only approved treatment for adolescents right now, he adds.

Deuruxolitinib (Leqselvi)

In 2024, the FDA approved deuruxolitinib for adults with severe alopecia areata, making it the third oral JAK inhibitor available in the United States. The twice-a-day medication also blocks JAK1 and JAK2.

Approval was based on two large phase 3 trials that included 1,200 people with at least 50 percent scalp hair loss. At 24 weeks, about 1 in 3 people achieved 80 percent scalp regrowth compared with 1 percent of those taking a placebo.

Deuruxolitinib is metabolized differently from the other approved JAK inhibitors, and you need to have a genetic test before starting treatment to ensure safe metabolism, says Mostaghimi.

Deuruxolitinib and baricitinib target the same pathways, but some people respond better to one than the other, he says. It’s a reminder that “switching between drugs in the same class can still work,” he adds.

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