UC Irvine

BACKGROUND: Janus kinase inhibitors (JAKis) have transformed the treatment of alopecia areata (AA), but not all patients respond to initial therapy. The utility of switching between JAKis in treatment-refractory AA remains underexplored. OBJECTIVE: To evaluate the efficacy and safety of switching between JAKis in patients with severe AA. METHODS: In this multicenter retrospective study, we analyzed 108 patients with severe AA who switched between oral JAKis after a minimum treatment duration of 6 months. Treatment response was assessed using the Severity of Alopecia Tool (SALT). Multivariable logistic regression was used to identify predictors of response to a second JAKi. RESULTS: Overall, 48.8% of patients achieved SALT ≤20 on their second JAKi, and 32.6% achieved SALT ≤10. Of 21 patients who received a third JAKi, 52.4% achieved SALT ≤20 and 38.1% achieved SALT ≤10. Patients who responded to their first JAKi were more likely to respond to a second (odds ratio, 3.33; 95% CI, 1.22-9.68; P = .022). Adverse events were mild and consistent with prior reports. LIMITATIONS: Retrospective design, treatment heterogeneity, and potential selection bias. CONCLUSIONS: Switching between JAKis appears to be a viable strategy for severe AA patients, especially those responding to prior JAKi. Prior response may help guide treatment sequencing.