Effectiveness of Abrocitinib in Adolescent Alopecia Areata: A Prospective Observational Pilot Study

Objective: Alopecia areata (AA) is a immune-mediated condition that affects patients’ quality of life, particularly among children and adolescents, and treatment options remain limited. This study aimed to explore the clinical effectiveness and safety of abrocitinib in seven adolescents with moderate-to-severe AA. Methods: This prospective observational study enrolled AA patients aged 12–17 years with a Severity of Alopecia Tool (SALT) score ≥ 25 who received abrocitinib treatment for at least 10 months between August 2023 and December 2024 at the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College. The primary endpoint was measured by the proportional reduction in SALT score between baseline and the most recent evaluation. Secondary endpoints included the proportion of patients achieving a SALT score ≤20 (SALT 20), SALT50, SALT75, and SALT90 at weeks 12, 24, 36, and the final visit, and safety assessments. Results: Seven patients (one boy and six girls), aged 12 to 17 years, completed a minimum of 10 months of therapy. The median baseline SALT score was 95 (IQR, 50–100), and the mean disease duration was 35.1 months. At week 12, 57.1% achieved SALT ≤20, increasing to 85.7% by week 24 and 100% by week 36; at the final visit, 85.7% maintained this response. SALT50/75/90 response rates improved from 71.4%/42.9%/28.6% at week 12 to 100%/85.7%/85.7% at week 24, reaching 100% each by week 36. The median percentage reduction in SALT score was 100% (mean, 90.6%; IQR, 47.4%–100%). Initial hair regrowth occurred after a mean duration of 7.7 weeks. No serious safety concerns were identified; one patient experienced mild transient bilirubin elevation. Conclusion: Abrocitinib demonstrated favorable efficacy and tolerability in adolescents with AA. The long-term clinical outcomes and safety considerations of abrocitinib and other JAK inhibitors in this age group remain to be established through adequately powered prospective trials.