JAK Inhibitors Show Promise Across Alopecia Subtypes, Says David Cotter, MD, PhD

At the 2025 Society of Dermatology Physician Assistant (SDPA) annual summer meeting in Washington, DC, David Cotter, MD, PhD, an assistant clinical professor at the University of Nevada, presented the session, “Hair Loss Track: JAK-ing Up Alopecia Areata,” on Friday, June 27th. In an on-site interview with HCPLive, Cotter discussed the rationale for targeting the JAK-STAT pathway in alopecia areata, as well as specific clinical or phenotypic patterns of this disease that appear to respond better or worse to JAK inhibition.

“What we see clinically is usually coin or circular-shaped areas of non-scarring alopecia that can transform and extend to be complete hair loss in the entire body, in things like alopecia universalis,” Cotter said. “Because of that, it makes a lot of sense to target the T cells to treat this disease, and when we think about some of the best T cell targeting medications that we have available to us, those are JAK inhibitors.”

Patients who respond the best to JAK inhibitors include those with limited disease. It is harder to treat alopecia universalis and totalis, although some medications work better for these alopecia types. An ophiasis pattern, which is a distribution of alopecia that runs from the temporal scalp down the occipital scalp, is even harder to treat.

“…but with Jak inhibitors, it really does even out the playing field,” Cotter said. “With these new medications, most people are able to get meaningful hair regrowth within a matter of time. When we think about what that matter of time is, though, it's never fast enough for anyone; we're talking about months, sometimes even out past a year, to get complete or clinically meaningful hair regrowth.”

When treating alopecia areata, Cotter always considers disease severity, comorbid diseases, and therapeutic options. For instance, for patients who have widespread scalp disease, he considers systemic therapy, such as baricitinib, ruxolitinib, and most recently, duruxalitib.

“We’ve got a wide array of medications to choose… that are currently FDA-approved on-label for the disease,” Cotter said. “[We are] looking at large network meta-analyses to ask the question: which drug is most effective at currently FDA-approved doses?”

References

Cotter, D. Hair Loss Track: JAK-ing Up Alopecia Areata. Presented at 2025 SDPA annual summer meeting 2025 on June 27th.