JAK Inhibitors in African American Patients With Alopecia Areata: A Case Series

Recent research suggests alopecia areata (AA) may affect racial and ethnic groups differently, with Black patients and people of color experiencing increased odds of developing the condition and having a greater disease burden [1-3]. Although JAK inhibitors (JAKi) have emerged as a promising treatment for AA, the response of Black patients to these therapies remains understudied, with Black and Hispanic/Latino patients generally underrepresented in trials [4]. This study aimed to investigate the experience and response of Black patients with AA receiving JAKi therapy. A retrospective case series was conducted to identify Black/African American patients who received JAKi treatment for AA at a specialty hair clinic within an academic dermatology department between 2018 and 2024. Demographics and clinical characteristics were collected for eligible patients, including the Severity of Alopecia Tool (SALT) score. The Wilcoxon signed-rank test with continuity correction and the unpaired t-test was used to calculate statistical significance. The study was approved by the Wake Forest University School of Medicine's institutional review board. Sixteen patients were included, 14 females and 2 males, with a mean age of 29.6 (Table 1). The average SALT score decreased from 66.7% (SD 25.2) before starting JAKi to 46.6% (SD 34.7) during treatment, resulting in a decrease averaging 20.1% (p = 0.045). The average duration of therapy was 21.4 months. Nine patients (56%) were prescribed baricitinib, followed by ritlecitinib (5 [31%]) and tofacitinib (2 [13%]). Adjunctive treatment was utilized by nine patients (56%), whereas seven patients (44%) were on JAKi as monotherapy (Table 2). The use of adjuvant medications did not contribute to a statistically significant difference in SALT scores (p > 0.05). Ten patients (63%) showed clinical improvement in hair loss, 2 (12%) maintained a stable state, and 3 (19%) were refractory to treatment. Of those patients refractory to therapy, two were trialed on two or more different JAKi. Presently, 15 patients remain on JAKi, whereas one patient discontinued treatment due to severe headache and nausea (Table 1). Eleven patients (69%) obtained their prescriptions through their health insurance with approved prior authorization, and 5 (31%) accessed them via a manufacturer's patient assistance program (Table 2). This study highlights the response of Black patients with AA treated using JAKi. The predominantly female representation reflects the higher prevalence of AA among women. Most patients were treated with baricitinib or ritlecitinib, both of which are U.S. Food and Drug Administration (FDA)-approved JAKi for AA in adults, with ritlecitinib additionally being the only FDA-approved JAKi for adolescents. Deuroxolitinib, the newest FDA-approved JAKi for adults, was not yet available in pharmacies at the time of this study. The majority responded favorably, with a 20% reduction in SALT score following treatment with JAKi, suggesting JAKi effectively reduces scalp involvement. A small subset showed no response to treatment, likely due to factors such as hair loss history exceeding 15 years and extensive scalp involvement before initiating JAKi therapy. Over half of the prescriptions were covered by insurance, reflecting improved access to these therapies following FDA approval. For those without drug coverage, manufacturer-patient assistance programs played a crucial role in facilitating access and enhancing greater equity in treatment availability. The study shows a high rate of continued JAKi use and positive treatment outcomes among Black patients, highlighting JAKi as a valuable consideration for managing AA in this population. Limitations of the study include its retrospective design, small sample size, lack of a control group, and data from a single academic dermatology clinic. Continued investigation is essential for monitoring this demographic's response to and tolerance of JAKi. Future studies may explore variations in cytokines and signaling pathways between different racial groups, as well as responses across different hair loss patterns. These future directions will provide clinicians with valuable insights to guide early intervention and treatment decisions. This study was reviewed and approved by the Wake Forest School of Medicine IRB (IRB00096160). Amy McMichael has received research, grants, and/or consulting support from Concert, Procter and Gamble, Incyte, Revian, Lilly, Janssen, Pfizer, Arcutis, Almirall, Abbvie, Cerave, Galderma, Bristol Meyers Squibb, Kenvue, Sanofi Regeneron, Sun Pharma, UCB, Pelage, Johnson & Johnson, L'Oreal, and Leo. She holds royalties from Informa/Taylor and Francis and McGraw Hill. The other authors have no conflicts to declare.