Comparative Efficacy of JAK Inhibitors in Acute vs Nonacute Alopecia Areata: A Retrospective Cohort Study

Authors

  • Ruxin Ji Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
  • Man Zhang Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
  • Tian Tian Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
  • Jundong Huang Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
  • Jia Jian Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
  • Min Li Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
  • Xiaobing Liang Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
  • Zhixiang Zhao Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratary of Aging Biology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; FuRong Laboratory, Changsha, China
  • Fangfen Liu Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratary of Aging Biology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; FuRong Laboratory, Changsha, China
  • Wei Shi Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratary of Aging Biology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; FuRong Laboratory, Changsha, China
  • Ji Li Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratary of Aging Biology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; FuRong Laboratory, Changsha, China
  • Shixin Duan Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratary of Aging Biology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; FuRong Laboratory, Changsha, China
  • Aike Wu Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratary of Aging Biology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; FuRong Laboratory, Changsha, China
  • Yan Tang Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratary of Aging Biology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; FuRong Laboratory, Changsha, China

DOI:

https://doi.org/10.2340/actadv.v106.adv-2025-0060

Keywords:

alopecia areata, tofacitinib, ritlecitinib, JAK inhibitors, super-responders

Abstract

Despite advancements in systemic treatments, the efficacy of Janus kinase (JAK) inhibitors in acute versus non-acute alopecia areata (AA) remains poorly defined, necessitating comparative studies to optimize therapeutic strategies. This retrospective, single-centercentre cohort study included 158 AAalopecia areata patients treated with JAKJanus kinase inhibitors (tofacitinib or ritlecitinib) between 2021 and 2025, aimed at evaluating clinical outcomes and identifying predictors of super-responder (SR) status. Patients were stratified into acute (n=41) and non-acute (n=117) groups based on disease duration and treatment history, with efficacy assessed using the Severity of Alopecia Tool (SALT) through week 24. Our findings demonstrate that patients with acute AAalopecia areata achieved significantly superior outcomes, with 65 % reaching SALT100 by week 24 compared to 39.5 % in the non-acute group (p=0.041). Binary logistic regression analysis further identified tofacitinib treatment (OR=2.883, p=0.009) and mild-to-moderate baseline severity (OR=2.802, p=0.015) as significant predictors of SRsuper-responder status, while acute AAalopecia areata status showed borderline predictive value (OR=2.418, p=0.098). Although limited by its single-centercentre design and sample size, this study underscores that early intervention with JAKJanus kinase inhibitors in acute AAalopecia areata leads to enhanced hair regrowth, emphasizing the critical importance of timely clinical management.

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Published

2026-05-25

How to Cite

Ji, R., Zhang, M., Tian, T., Huang, J., Jian, J., Li, M., … Tang, Y. (2026). Comparative Efficacy of JAK Inhibitors in Acute vs Nonacute Alopecia Areata: A Retrospective Cohort Study. Acta Dermato-Venereologica, 106, adv–2025. https://doi.org/10.2340/actadv.v106.adv-2025-0060

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Vol. 106 (2026)

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