Merve Küçükşahin, Erhan Ayhan
Turkish Journal of Dermatology - 2025;19(4):227-234
Aim: Alopecia areata (AA) is an autoimmune, non-scarring hair loss disorder in which interferon-gamma/ interleukin-15 signaling amplifies inflammation via the Janus kinase (JAK)/STAT pathway, providing a mechanistic rationale for oral JAK inhibition. To assess the real-world effectiveness and safety of oral baricitinib and tofacitinib in AA and to examine clinical and lifestyle predictors of treatment response. Materials and Methods: We retrospectively reviewed 65 patients (age 7-55 years) with AA/AT/AU who received tofacitinib or baricitinib at a tertiary dermatology clinic (Dicle University, Türkiye) between 15 August 2021 and 29 March 2024. Disease severity was assessed by the Severity of Alopecia Tool (SALT). The primary outcome was the change in SALT from pre- to post-treatment. Responses were categorized into no (0-24.9%), partial (25-49.9%), good (50-74.9%), or excellent (75-100%) reduction. Analyses were used paired t-tests, one-way ANOVA, with Bonferroni post-hoc tests, Pearson correlations, and chi²/Fisher's exact tests (two-tailed, P <= 0.05). Ethics approval was obtained, and procedures conformed to the Declaration of Helsinki. Results: Cohort characteristics included AU 63.1%, AT 10.8%, AA 23.1%; severe SALT (50-100) in 86.2%. Overall SALT decreased from 91.15+/-18.76 to 49.08+/-38.20 (P = 0.001). In subgroup analyses, SALT fell from 96.80+/-7.61 to 43.40+/-40.63 when using tofacitinib (P = 0.020) and from 86.09+/-23.04 to 45.71+/-35.55 when using baricitinib (P < 0.001). Response distributions were as follows: tofacitinib-50.0% no, 6.0% partial, 6.0% good, 38.0% excellent; baricitinib-23.1% no, 20.5% partial, 10.3% good, 46.1% excellent. Between-drug SALT differences were not significant (ANOVA F = 1.66, P = 0.198). Tofacitinib duration correlated with greater improvement (r = 0.415, P = 0.001) and was longer in excellent responders compared to non-responders (23.08+/-17.95 vs. 6.28+/-5.19 months, P = 0.005); no duration-response correlation was observed with baricitinib (P = 0.671). Conclusion: In a severe, predominantly AU cohort, oral JAK inhibitors produced clinically meaningful SALT reductions with acceptable safety. Effectiveness appeared comparable between agents, while longer tofacitinib exposure was associated with greater benefit, whereas baricitinib achieved substantial responses over shorter intervals. Prospective studies should clarify the roles of treatment duration, clinical phenotype, and lifestyle/metabolic factors in optimizing outcomes.
