What type of study is this?

This is a Systematic Review study.

October 13, 2025

Comparative Efficacy of Janus Kinase Inhibitors Indicated for Severe Alopecia Areata: A Bayesian Network Meta‐Analysis and Matching‐Adjusted Indirect Comparison

Key Points

Deuruxolitinib 8 mg shows significantly better efficacy compared to baricitinib on SALT endpoints, providing a potential treatment advantage.
In a cohort of 4560 participants from seven RCTs, deuruxolitinib consistently ranked highest in short-term efficacy evaluations.
Bayesian network meta-analysis and multilevel network meta-regression modeled overall treatment effectiveness, indicating strong results for deuruxolitinib.
Findings pose the need for careful interpretation and further confirmation before making definitive treatment guidelines.

Abstract

ABSTRACT Systemic Janus kinase inhibitors (JAKIs) have markedly advanced the therapeutic landscape for alopecia areata (AA). Although baricitinib and ritlecitinib are approved in the United States (US) and Europe, and deuruxolitinib in the US for severe AA, the lack of head‐to‐head randomized controlled trials (RCTs) limits evidence‐based prescribing decisions. Moreover, prior meta‐analyses excluded data on certain oral JAKIs or incorporated findings from agents and dosing regimens that were abandoned, investigational, clinically ineffective, or associated with unacceptable safety profiles. To compare the efficacy of oral JAKIs, limited to FDA, EMA, or MHRA approved drugs and doses—baricitinib (2 and 4 mg QD), ritlecitinib (50 mg QD), and deuruxolitinib (8 mg BID)—for severe AA, using advanced indirect comparison methodologies. A systematic review was performed following PRISMA 2020 guidelines (CRD420251116775). Bayesian network meta‐analysis (NMA) synthesized data from RCTs reporting Week 24 outcomes on Severity of Alopecia Tool (SALT) ≤ 10 and SALT ≤ 20 thresholds. Multilevel network meta‐regression (ML‐NMR) evaluated heterogeneity and adjusted for baseline imbalances. Additionally, unanchored matching‐adjusted indirect comparisons (MAIC) were conducted using individual patient‐level data from THRIVE trials. Surface under the cumulative ranking (SUCRA) values were calculated to rank treatments. Seven RCTs ( n = 4560 participants) were included. Deuruxolitinib 8 mg significantly outperformed baricitinib 2 and 4 mg on both SALT endpoints. Differences with ritlecitinib 50 mg were directionally favorable for deuruxolitinib but not statistically significant in NMA and ML‐NMR models. MAICs confirmed superior odds for deuruxolitinib versus baricitinib 2 mg (OR = 71.55) and ritlecitinib (OR = 18.27) for SALT ≤ 20. SUCRA rankings also consistently favored deuruxolitinib. Among approved oral JAKIs, deuruxolitinib 8 mg shows the highest short‐term efficacy for severe AA. These findings provide preliminary evidence to guide treatment decisions but should be interpreted as exploratory pending confirmation.

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