JAK Inhibitors in Alopecia Areata: Long-Term Success, Individualized Strategy, and the Emerging Role of Eyebrow Outcomes

At the Fall Clinical 2025 session, “ ‘Hair’ For the Long Haul: Alopecia Areata Cases and Considerations,” Adelaide A. Hebert, MD, and Karan Lal, DO, explored the clinical nuances of treating alopecia areata (AA) with Janus kinase (JAK) inhibitors. Through patient cases and data review, the presenters emphasized the need to think beyond the scalp, personalize treatment duration and dosing, and recognize the growing significance of eyebrow regrowth as a marker of patient satisfaction.

Dr Hebert outlined the 3 JAK inhibitors now available for AA:

• Baricitinib (approved in 2018): A JAK1/2 inhibitor with once-daily dosing. Approved for adults ages 18 years and up in the United States
• Ritlecitinib (approved 2023): A JAK3/TEC inhibitor with once-daily 50 mg dosing and the only agent approved down to age 12 years. No lipid monitoring is required.
• Deuruxolitinib (approved 2024): A JAK1/2 inhibitor with twice-daily dosing. Requires lipid profile monitoring and CYP2C9 variant testing before initiation.

“The fact that we can actually give a patient a pill and have them regrow their hair was unimaginable just a few years ago,” Dr Hebert said. “This has been a revolution in alopecia areata treatment.”

She emphasized that insurance coverage is aligned with US Food and Drug Administration indications: ages 18 years and up for baricitinib and deuruxolitinib, and ages 12 years and up for ritlecitinib, which included adolescents in the pivotal trial.

Deuruxolitinib’s Severity of Alopecia Tool score data showed 48.8% achieving response by week 24, with gains maintained through long-term follow up. Baricitinib demonstrated strong durability over 152 weeks, with hair regrowth sustained in both 2 mg and 4 mg groups.

“These people are keeping their hair,” Dr Hebert said. “It’s not just a brief window—this is long-term control.”

Ritlecitinib’s long-term data also demonstrated consistent response beyond the primary endpoint, with all placebo patients converted to active drug in the extension phase. “We got very, very nice data in this study,” she added.

Laboratory monitoring requirements differ:

• Baricitinib and deuruxolitinib both require lipid panels
• Ritlecitinib does not require lipid monitoring
• Deuruxolitinib requires CYP2C9 genotyping, a test ordered via LabCorp and billed to the manufacturer, not the patient

“This is a big advantage,” Dr Hebert noted. “It’s not difficult to order, and reps can provide the forms and walk your staff through it.”

Dr Lal shifted focus to the patient perspective, referencing a Journal of Investigative Dermatology (JID) study on AA severity classification that incorporates not just scalp hair loss but also eyebrow and eyelash loss, psychosocial impact, and treatment resistance.

He highlighted findings from the JID Symposium showing that:

• Patients with full scalp regrowth but no eyebrow regrowth had only 33% satisfaction
• Those with full eyebrow regrowth but no scalp hair reported 69% satisfaction
• Patients with full eyebrow plus partial scalp regrowth had 51% satisfaction
• Only patients with both full scalp and eyebrow regrowth achieved 91% satisfaction

“This tells us that eyebrow regrowth is not optional—it’s a key outcome for many patients,” Dr Lal said. He emphasized its importance in male patients, who may not voice this need as readily.

Dr Hebert shared a case of a male waiter in a ritlecitinib study who regrew full scalp hair but not brows. After insisting on intralesional triamcinolone injections, he experienced regrowth—contrary to expectations.

“He begged me to try,” she said. “He was right. I was wrong. We’re publishing the case. It’s humbling when your patients bring insights we didn’t expect.”

Dr Lal presented a case of a 34-year-old man with progressive multifocal AA and suspected overlapping male pattern baldness. After failing methotrexate, prednisone, oral minoxidil, and steroids, he was started on baricitinib 4 mg.

At 1 year, he had complete regrowth, maintained even after tapering to 2 mg. “He had no adverse events and accepted his male pattern hair distribution. That’s what he wanted.”

Dr Lal emphasized the importance of recognizing dual diagnoses: “Sometimes people have more than 1 condition. You have to tease that out.”

The current generation of JAK inhibitors for AA represents a turning point in disease control. As Dr Hebert concluded, “We can now offer patients reliable, durable regrowth, and tailor therapy to what matters most to them.” For many, that includes not just hair on their head, but brows that shape identity, confidence, and satisfaction. Dermatologists must continue to adapt, not only to the pharmacology, but to what patients value most.

Reference
Herbert A, Lal K. ‘Hair’ for the long haul: alopecia areata cases and considerations. Presented at: 2025 Fall Clinical Dermatology Conference. October 23–26, 2025; Virtual.