Real-World Effectiveness of JAK Inhibitors for Alopecia Totalis and Alopecia Universalis: A Single-Center Experience

Background: Severe alopecia areata (AA), including alopecia totalis (AT) and alopecia universalis (AU), can cause diffuse thinning or complete loss of scalp and body hair. Janus kinase (JAK) inhibitors have revolutionized AA treatment, but clinical data on AT/AU patients remain limited. This study examines the clinical response to JAK inhibitors in AT/AU patients at a single center in China. Methods: This retrospective observational study was designed to include patients diagnosed with AT/AU between February 2021 and August 2024. The primary endpoint was the proportion of patients achieving a Severity of Alopecia Tool (SALT) score of 20 or less at week 24. Treatment-related adverse events (AEs) were evaluated at each follow-up visit. The last observation carried forward was used for the missing SALT value. Results: Dispensation of tofacitinib (55.6%, n = 25) was the most common, followed by ritlecitinib (31.1%, n = 14) and baricitinib (13.3%, n = 6). Among these 45 patients, the mean ± SD baseline SALT score was 99.2 ± 1.6, which progressively decreased to 72.6 ± 29.8 at week 12, 44.2 ± 39.6 at week 24, and 27.4 ± 38.7 at week 36. At week 12, the proportion of patients achieving a SALT score ≤20 was 16.7% (1/6) for baricitinib, 7.1% (1/14) for ritlecitinib, and 4.0% (1/25) for tofacitinib. By week 24, response rates improved significantly, with ritlecitinib demonstrating the highest response rate at 50.0% (7/14), followed by tofacitinib at 48.0% (12/25) and baricitinib at 16.7% (1/6). No serious AEs were reported. Conclusions: This study confirms the effectiveness and safety of JAK inhibitors for patients with AT and AU in a real-world setting. These findings align with clinical trial results and reinforce the JAK inhibitor’s role as a viable treatment option for AA.