Subgroup Case Series Reveals JAKi Efficacy for Black Patients With AA

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Recent studies have increasingly recognized that alopecia areata (AA) affects racial and ethnic groups differently, with Black individuals and patients with skin of color facing a higher likelihood of developing the disease and experiencing greater severity.¹ However, despite the emergence of Janus kinase inhibitors (JAKi) as promising treatments for AA, Black and Hispanic/Latino populations have historically been underrepresented in clinical trials evaluating these therapies.² In response to this gap, a recent retrospective case series examined the clinical response of Black patients with AA treated with JAK inhibitors at a specialty hair clinic within an academic dermatology department.³

Study Design and Patient Demographics

The study, conducted between 2018 and 2024, included 16 self-identified Black/African American patients, comprising 14 women and 2 men, with a mean age of 29.6 years. Clinical characteristics, including Severity of Alopecia Tool (SALT) scores, were collected before and during JAKi therapy. Statistical analyses were performed using the Wilcoxon signed-rank test with continuity correction and the unpaired t-test to determine significance. Institutional review board approval was obtained from Wake Forest University School of Medicine.

Prior to treatment initiation, the average SALT score among patients was 66.7% (SD 25.2). Following JAKi therapy, this score decreased to an average of 46.6% (SD 34.7), corresponding to a statistically significant 20.1% reduction in scalp involvement (p = 0.045). Patients were treated for an average duration of 21.4 months.

Treatment Modalities and Outcomes

The study found the most commonly prescribed JAK inhibitors were baricitinib (56%) and ritlecitinib (31%), with tofacitinib used in 13% of cases. Approximately half of the patients (56%) received adjunctive therapies alongside JAKi, though adjunctive use did not significantly affect SALT score changes (p > 0.05).

Clinical improvement was observed in 63% of patients, while 12% maintained disease stability and 19% were refractory to therapy. Notably, 2 of the refractory patients had been treated with multiple JAK inhibitors. At the study’s conclusion, 15 of 16 patients continued therapy, with 1 patientdiscontinuing due to adverse events, specifically severe headache and nausea.

In terms of medication access, 69% of patients were able to obtain their JAKi prescriptions through insurance with prior authorization, while 31% utilized manufacturer patientassistance programs.

Interpretation and Clinical Implications

This study demonstrates that JAK inhibitors can effectively reduce scalp involvement in Black patients with AA, with a majority showing clinical improvement and a relatively high rate of treatment continuation. The predominance of women in the study aligns with the known higher prevalence of AA among women. Most patients were treated with FDA-approved therapies (baricitinib or ritlecitinib), with ritlecitinibnotable for being the only JAKicurrently approved for adolescents.

The findings also underscore the importance of expanded access initiatives, such as insurance coverage and patientassistance programs, which were pivotal for nearly one-third of the cohort. Such programs play a critical role in ensuring equitable access to emerging therapies for historically underserved populations.

Study Limitations and Future Directions

Despite its encouraging findings, the study is limited by its retrospective design, small sample size, lack of a control group, and being based at a single center. These factors restrict the generalizability of results.

Researchers stated further research is needed to better understand the long-term efficacy and safety of JAKi among diverse populations. They suggested future studies should aim to explore biological differences, including variations in cytokine profiles and disease patterns across racial and ethnic groups. Such investigations may enhance early identification strategies and optimize treatment approaches tailored to specific patient populations.

Overall, researchers concluded that JAK inhibitors represent a valuable therapeutic option for Black patients with alopecia areata, warranting continued attention in clinical research to ensure broader, more inclusive understanding and care strategies.

References

1. Lee H, Jung SJ, Patel AB, Thompson JM, Qureshi A, Cho E. Racial characteristics of alopecia areata in the United States. J Am Acad Dermatol. 2020;83(4):1064-1070. doi:10.1016/j.jaad.2019.06.1300
2. Sy N, Mastacouris N, Strunk A, Garg A. Overall and racial and ethnic subgroup prevalences of alopecia areata, alopecia totalis, and alopecia universalis. JAMA Dermatol. 2023;159(4):419-423. doi:10.1001/jamadermatol.2023.0016
3. Mukenge MM, Rao S, Obeime I, Larrondo J, Palmer V, McMichael A. JAK inhibitors in African American patients with alopecia areata: A case series. Int J Dermatol. Published online April 24, 2025. doi:10.1111/ijd.17763