BH14 Irish dermatologists’ experience with Janus kinase inhibitors in alopecia areata

Abstract Alopecia areata (AA) is a chronic, relapsing, immune-mediated, inflammatory disorder that affects hair follicles and results in nonscarring hair loss. The impressive efficacy of JAK inhibitors (JAKis) in AA has been described in several studies. However, there is currently limited information on the long-term safety of JAKi use in patients with AA, and few guidelines for long-term use. We sought to evaluate Irish dermatologists’ practices regarding the use of JAKis in AA. We disseminated a questionnaire through the Irish Association of Dermatologists to dermatology consultants practising in Ireland, via electronic mailing lists. Overall, 21 questionnaires were completed (response rate 17%). Overall, 90% of respondents had experience with JAKis in AA (range 0 to ≥ 5 years). The most frequent factors that influenced the decision to commence a JAKi therapy in AA were patient’s Dermatology Life Quality Index and age, followed by patient’s comorbidities, literature on long-term effects and cost reimbursement. Interestingly, the first JAKi option in AA was reported as baricitinib (81%). Most respondents (76%) reported that they assess the AA response to a JAKi 3 or 6 months after initiation. For the second JAKi option (if the first fails), 47% of respondents chose tofacitinib, followed by upadacitinib (24%). After achieving a response to JAKi, practice varies widely regarding ongoing continuation of therapy, with a range of different approaches reported including weaning strategies. Around 95% of respondents stated an urgent need for guidelines regarding optimal use of JAKis in AA. AA poses challenges to clinicians. While JAKis show impressive efficacy, in the absence of clear literature and global guidelines to assist clinicians managing AA with JAKis, practice varies considerably.