Treatment Response to JAK Inhibitors in Long-standing Alopecia Areata (≥8 Years): A Real-world Observational Study

Long-standing alopecia areata is a therapeutically challenging subgroup lacking robust evidence regarding Janus kinase (JAK) inhibitors. This retrospective, single-centre study evaluated the efficacy and safety of baricitinib, tofacitinib or ritlecitinib in patients with current alopecia areata episodes lasting ≥8 years, treated between February 2021 and December 2025. Among 41 screened patients, 31 met the inclusion criteria (mean age 24.6±10.1 years; mean episode duration 12.7±4.6 years). The mean baseline SALT score was 62.8±30.2, with 64.5% of patients presenting a baseline SALT score ≥50. At week 24 (n=29), 27.6% and 24.1% of patients achieved absolute SALT scores ≤20 and ≤10, respectively. Relative improvements (SALT30, SALT50 and SALT80) were observed in 48.3%, 31.0% and 24.1% of patients. Treatment discontinuation occurred in 58.1% (18/31) of patients, primarily driven by a lack of efficacy (66.7% of these discontinuations). The most frequent adverse events were folliculitis (22.6%) and acne (12.9%). While the overall therapeutic response to JAK inhibitors remains limited in long-standing alopecia areata, a subset achieves clinically meaningful hair regrowth, supporting their use as a viable treatment option.