Upadacitinib for Alopecia: Current Evidence and Clinical Insights.

Background: Upadacitinib, a selective Janus kinase (JAK) 1 inhibitor, has demonstrated promising efficacy in alopecia areata (AA), particularly in patients unresponsive to conventional therapies. As JAK inhibitors gain prominence, understanding upadacitinib's role in AA management is critical.

Summary: This scoping review synthesizes data from 24 publications, including 64 AA patients treated with upadacitinib (15-45 mg daily). Most patients experience substantial or complete hair regrowth within 1-4 months. The most common AA subtypes include alopecia universalis (n = 28), ophiasis (n = 15), and alopecia totalis (n = 8). Upadacitinib was generally well tolerated, with mild adverse events such as transient acneiform eruptions, leukopenia, and creatine phosphokinase elevations. Many patients with comorbid autoimmune conditions, such as atopic dermatitis (59.4%) and inflammatory bowel disease, also reported improvement. Despite these promising findings, limitations include small cohort sizes, variability in prior treatments, and reliance on case reports. Two ongoing studies are underway: a US Phase 3 clinical trial (M23-716) assessing long-term efficacy and safety, and a real-world observational study in China (NCT06573593) comparing upadacitinib with other JAK inhibitors. These studies underscore the need for larger, controlled trials to establish standardized treatment protocols and long-term safety outcomes.

Key messages: (i) Upadacitinib demonstrates good efficacy in treating AA. (ii) Its safety profile supports potential off-label use. (iii) Larger studies are essential to validate current findings and optimize management.