Patients with alopecia areata showed improved response rate with oral Janus kinase (JAK) inhibitors vs topical and sublingual JAK inhibitor administration.
Oral administration of Janus kinase (JAK) inhibitors may provide better efficacy vs topical and sublingual formulations in the treatment of alopecia areata (AA), according to study findings published in Frontiers in Pharmacology.
Although several therapeutic approaches are available for the management of AA, including corticosteroids, minoxidil, and topical immunotherapy, responses to these treatments vary widely, the researchers noted, with adverse events occuring especially frequently in systemic medications.
In exploring more effective and less toxic drugs for AA, targeted therapies, including JAK inhibitors, are considered to be a preferable treatment option. But there remains a lack of comprehensive evidence based on prospective studies regarding the efficacy and safety of these drugs in AA.
“Clinical statistics regarding the efficacy and safety of JAK inhibitors are required to provide a better insight in this new treatment strategy,” wrote the study authors.
They conducted a systematic review and subsequent meta-analysis to evaluate the safety and efficacy of JAK inhibitors for AA. Additional subgroup analyses were conducted to determine the relative efficacy of JAK inhibitors in different administration route (oral vs topical vs sublingual administration) and to identify more factors influencing the good response to JAK inhibitors in patients with AA.
Clinical studies registered in the PubMed, EMBASE, and Cochrane library databases from inception to June 17, 2022 that evaluated the efficacy and safety of the JAK inhibitors tofacitinib, ruxolitinib, baricitinib, ritlecitinib, and brepocitinib were eligible for inclusion in the systematic review.
“The efficacy outcomes included good response (defined as 50% improvement in Severity of Alopecia Tool [SALT] scores), complete response (defined as 90% improvement in SALT scores), the percent change from baseline in SALT score, and recurrence. The safety outcomes included the incidence rates of adverse events,” noted the study authors.
After evaluation of potentially relevant reports, 14 studies (5 randomized controlled trials [RCTs] and 9 non-RCTs), enrolling a total of 1845 patients, were included for quantitative analysis. Non-RCTs included comparative efficacy data on the oral, topical, and sublingual administration of JAK inihibitors, and RCTs included data on only oral and topical formulations.
Specific to RCTs, oral JAK inhibitors exhibited a significantly higher good response rate (RR) compared with controls (RR, 6.86; 95% CI, 2.91-16.16), whereas topical JAK inhibitors did not show any difference compared with controls (RR, 1.00; 95% CI, 0.31–3.18).
The pooled rate of good response in the non-RCTs for oral, topical, and sublingual JAK inhibitors were 63% (95% CI: 44%–80%), 28% (95% CI: 1%–72%), and 11% (95% CI: 1%–29%), respectively, again showing the greater good response observed with oral formulations. No significant difference based on the route of administration was observed for complete response.
Regarding recurrence outcomes, the pooled recurrence rate in patients treated with JAK inhibitors was 54% (95% CI: 39%–69%), mainly due to the withdrawal of JAK inhibitors. No difference was observed in the risk of experiencing adverse events in the RCTs, with reported adverse events with high incidence rate in the non-RCTs indicated to be mostly mild and manageable.
Researchers noted that one of the major limitations of the review was the high heterogeneity of the studies, which could result from the inclusion of 3 routes of administration.
“For this reason, a random effects model was used and subgroup analyses were conducted to reduce heterogeneity,” they added.
They concluded that the high recurrence rate after withdrawal of JAK inhibitors warrants consideration for continuous treatment to maintain efficacy.
Reference
Yan D, Fan H, Chen M, et al. The efficacy and safety of JAK inhibitors for alopecia areata: A systematic review and meta-analysis of prospective studies. Front Pharmacol. 2022;13:950450. doi:10.3389/fphar.2022.950450
Real-World Data Show Sotorasib Effective for NSCLC With KRAS Mutation
May 18th 2024Data from real-world and clinical-trial settings on frontline monotherapy treatment with the KRAS inhibitor sotorasib both show similar progression-free survivals and a high likelihood that the treatment’s efficacy is not affected with dose reduction.
Read More
Health Equity and Access Weekly Roundup: May 18, 2024
May 18th 2024The US Senate hosted a panel addressing physician and health care shortages and efforts to increase minority representation in the medical field. An expert discussed initiatives to prevent senior homelessness. Advocates called for the repeal of the Comstock Act. Regulatory reforms are called for to improve rural cancer patients' access to pharmacies. Research reveals the impact of denials on patient access to immunology treatments.
Read More
Frameworks for Advancing Health Equity: Urban Health Outreach
May 9th 2024In the series debut episode of "Frameworks for Advancing Health Equity," Mary Sligh, CRNP, and Chelsea Chappars, of Allegheny Health Network, explain how the Urban Health Outreach program aims to improve health equity for individuals experiencing homelessness.
Listen
Study Highlights Significant Increases in Utilization, Spending on DMD Drugs in Medicaid
May 17th 2024The findings add to recent research on the growing utilization, expenditure, and prices of Duchenne muscular dystrophy (DMD) therapies in the current landscape, an area health care policy could potentially address.
Read More