Experiences with JAK Inhibitors Highlighted Among Black Patients with Alopecia Areata

A new case series points to a high rate of continued Janus Kinase (JAK) inhibitor utilization and positive treatment outcomes among patients with alopecia areata who are Black or African American, with over half of JAK inhibitor prescriptions having been covered via insurance.1

This case series was led by such investigators as Megan M. Mukenge, an MD candidate from the department of dermatology at Wake Forest University School of Medicine. Mukenge and colleagues highlighted that recent analyses prior to this case series have suggested differing impacts of alopecia areata on various racial and ethnic groups, with greater disease burdens being observed among patients identifying as Black.

“Although JAK inhibitors (JAKi) have emerged as a promising treatment for [alopecia areata], the response of Black patients to these therapies remains understudied, with Black and Hispanic/Latino patients generally underrepresented in trials,” Mukenge and colleagues wrote. “This study aimed to investigate the experience and response of Black patients with [alopecia areata] receiving JAKi therapy.”1,2

The investigative team assessed Black/African American patients using a retrospective case series, looking specifically at individuals in this patient population who had undergone treatment with JAKi for alopecia areata at a specialized hair clinic within an academic dermatology department in the period between 2018 - 2024.

Various demographic data were collected by Mukenge and colleagues on these individuals, along with clinical information such as Severity of Alopecia Tool (SALT) scores. They evaluated statistical significance through the use of the Wilcoxon signed-rank test with continuity correction and the unpaired t-test.

There were 16 individuals evaluated in this case series, with 14 women and 2 men specifically. These patients had an average age of 29.6 years. The investigative team revealed that mean SALT scores of these patients had dipped from 66.7% before initiating JAKi therapy to 46.6% over the course of treatment.

This decline in SALT scores corresponded to an average reduction of 20.1% (P = .045). There was an average treatment duration of 21.4 months among the study's subjects, with the most commonly-prescribed JAK inhibitor being baricitinib (56%).

Ritlecitinib was the next most-used JAKi, among 31%, followed by tofacitinib among 13% of those evaluated in the case series. Utilization of adjunctive medications was observed in 56% of the patients assessed in the study, while 44% received a JAKi as a monotherapy.

Regarding access to JAK inhibitor medications, 69% were found by the research team to be able to obtain their treatments through insurance with prior authorization. 31% of subjects could access medications using manufacturer-sponsored patient assistance programs.

A statistically significant difference in SALT score changes was not observed by the investigators with the addition of adjunctive treatments (P > .05). Clinically, improvements related to regrowth in hair were seen in 63% of subjects. However, 12% remained stable and 19% would be classified by the investigative team as having been treatment refractory. Among those in the refractory case group, 2 individuals had trialed multiple JAK inhibitors. By the time of data collection, 15 individuals remained with JAKi therapy.

One of these individuals discontinued as a result of adverse effects, specifically nausea and severe headache.

Overall, the retrospective case series underscores the outcomes of treatment usinf JAKi among patients with alopecia areata who identify as Black. The predominance of female participants was noted by the team as reflecting the greater prevalence of alopecia areata observed in women.

Both of the most commonly-implemented JAK inhibitors in this analysis were noted as having been approved by the US Food and Drug Administration (FDA) for alopecia areata therapy in adults. Ritlecitinib is also approved by the FDA for adolescents.

The positive results observed by Mukenge et al. in terms of SALT scores suggest that JAK inhibitors are effective in scalp involvement reductions among those with alopecia areata. A minority had not responded to JAKi, a finding potentially linked to longstanding disease duration (over 15 years) and extensive scalp involvement at the time of medication initiation.

The investigators further highlight that those without insurance coverage may require manufacturer assistance programs, a program they noted promotes greater equity. The case series's results highlight a high rate of ongoing JAKi use and favorable treatment outcomes, supporting the use of JAK inhibitors as an important therapeutic option among Black patients with this hair loss condition.

“Future studies may explore variations in cytokines and signaling pathways between different racial groups, as well as responses across different hair loss patterns,” they wrote.1 “These future directions will provide clinicians with valuable insights to guide early intervention and treatment decisions.”

References

1. Mukenge MM, Rao S, Obeime I. Larrondo, et al (2025). JAK Inhibitors in African American Patients With Alopecia Areata: A Case Series. Int J Dermatol. https://doi.org/10.1111/ijd.17763.

2. O Ezemma, S Devjani, B Jothishankar, et al. “Racial and Ethnic Diversity in Janus Kinase Inhibitor Alopecia Areata Clinical Trials: A Systematic Review,” Skin Appendage Disorders 9, no. 5 (2023): 351–354, https://doi.org/10.1159/000531219.