Criteria for Commencing and Continuing Subsidised Janus Kinase Inhibitor Therapy in Australian Alopecia Areata Patients-Results From an Australian Expert Consensus Exercise.

Abstract

Background/objectives: Janus kinase inhibitors (JAKis) have been approved by the Therapeutic Goods Administration for severe alopecia areata (AA) in Australia. However, access is limited as JAKis are not currently subsidised on the Pharmaceutical Benefits Scheme for this indication. This study aimed to establish expert consensus on criteria for initiating and continuing subsidised JAKi therapy for AA.

Methods: An eDelphi study was conducted with 26 Australian specialists in hair and scalp disorders, who participated in two online survey rounds. A third round, held as a virtual meeting, facilitated discussion. Consensus was defined as ≥ 75% agreement or disagreement.

Results: Twenty-six, twenty-two, and twenty-five experts completed the first, second, and third rounds, respectively. Experts agreed that JAKis were nearly always the best treatment for cases with ≥ 50% scalp hair loss and usually the best treatment for 21%-49% scalp hair loss. The most important additional factors when assessing eligibility for JAKis were refractory disease, rapid progression, psychosocial morbidity, poorly camouflaged hair loss, ophiasis pattern, and impaired quality of life. Treatment failure was defined as < 50% improvement in scalp hair loss after 12 months of therapy. Indicators of remission included achieving SALT 0, regrowth of facial hair, improved DLQI scores, patient satisfaction, negative hair pull test, and reduced psychosocial impairment.

Conclusions: This expert consensus provides a framework for determining eligibility for subsidised JAKi therapy in Australian AA patients. Future research, supported by patient registries, should incorporate patient perspectives to further refine these criteria, ensure equitable access to treatment, and assess real-world impact, safety, and effectiveness.