The Relative Efficacy and Safety of Monotherapies for Alopecia Areata: A Network Meta-Analysis Study

Abstract

Background

Scant evidence exists for the relative efficacy of therapies for alopecia areata (AA)—including those approved by the Food and Drug Administration, namely, baricitinib, deuruxolitinib, and ritlecitinib.

Aims

We determined the relative efficacy and safety of monotherapy with janus kinase inhibitors (JAKIs), apremilast, and dupilumab.

Methods

Following a systematic review, we conducted Bayesian network meta-analysis (NMAs) that produced Surface Under the Cumulative RAnking (SUCRA) values and point estimates for pairwise relative effects; we also performed sensitivity analyses.

Results

In total, regimens with eight various JAKIs were compared, namely, ruxolitinib, ATI-501, baricitinib, brepocitinib, deuruxolitinib, ivarmacitinib, ritlecitinib, and tofacitinib. Our analyses ranked “deuruxolitinib 12 mg twice daily for 24 weeks,” the most efficacious insofar as “proportion of participants achieving SALT ≤ 20 at 24 weeks” (SALT₂₀) (SUCRA = 92.6%), and “proportion of participants achieving SALT ≤ 10 at 24 weeks” (SALT₁₀) (SUCRA = 97.7%). As per SALT₂₀, the highest-ranked regimen was more efficacious than “baricitinib 2 mg once daily for 24 weeks” (odds ratio [OR] = 5.37, 95% credible interval [CI] = 1.59, 13.70, p < 0.05). Furthermore, the efficacy of the FDA-approved JAKIs exhibited a dose-dependent relationship; for instance, baricitinib 4 mg once daily for 24 weeks was more efficacious than “baricitinib 2 mg once daily for 24 weeks” in terms of SALT₂₀ (OR = 2.25, 95% CI = 1.56, 3.21, p < 0.05). Results from our sensitivity analyses support that our base analyses were robust.

Conclusions

We produced high-quality evidence on the comparative effectiveness of monotherapies for AA with various regimens of 8 JAKIs, including the FDA-approved ones. Our findings can improve clinicians' decision-making and update guidelines for medical practice.