# Efficacy of Janus Kinase Inhibitors in Alopecia in Jordanian Patients: A Retrospective Cohort Study

## TL;DR

This study found that JAK inhibitors, especially baricitinib, helped Jordanian patients with alopecia areata regrow hair more effectively than tofacitinib.

## Contribution

The study provides new evidence on the efficacy of JAK inhibitors in Jordanian patients, highlighting baricitinib's better performance in late-stage treatment.

## Key findings

- Baricitinib users showed greater improvement in SALT scores between six to 12 months compared to tofacitinib users.
- Baricitinib had a trend toward greater total improvement at 12 months, suggesting better long-term efficacy.
- Baricitinib showed numerically higher ClinRO improvement in eyebrows and eyelashes, though not statistically significant.

## Abstract

Introduction

Alopecia areata (AA) is an autoimmune disorder causing non-scarring hair loss on the scalp, eyebrows, eyelashes, and other areas. Janus kinase (JAK) inhibitors have emerged as promising treatments, but data on their efficacy in Middle Eastern populations, including Jordanians, are limited. The Severity of Alopecia Tool (SALT) score is commonly used to assess disease severity, while Clinician-Reported Outcome (ClinRO) measures provide additional insights.

Aim

To evaluate the efficacy of JAK inhibitors in Jordanian AA patients using the SALT score as the primary outcome measure.

Methods

A retrospective cohort study was conducted at King Hussein Hospital, Jordanian Royal Medical Services, from January 2020 to December 2023. Medical records of AA patients aged ≥18 years treated with JAK inhibitors were reviewed. Data included demographics, disease duration, previous treatments, and adverse effects. Efficacy was assessed by the percentage change in SALT scores at six and 12 months. Statistical analyses included repeated-measures MANCOVA (Multivariate Analysis of Covariance), Chi-square, and independent t-test. A p-value <0.05 was considered significant.

Results

Our analysis included 57 patients, of which 31 (54.4%) received tofacitinib and 26 (45.6%) received baricitinib. A significantly higher proportion of baricitinib users had treatment durations >12 months (53.8%) compared to tofacitinib users (12.9%), while shorter durations (three to six months) were more common among tofacitinib users (41.9% vs. 15.4%; p = 0.003). Baricitinib users showed greater improvement in SALT scores between six to 12 months (92.77% vs. 82.93%; p = 0.030, partial η² = 0.084), with a trend toward greater total improvement at 12 months (96.64% vs. 93.11%; p = 0.055, partial η² = 0.067). Although not statistically significant, baricitinib showed numerically higher ClinRO improvement in eyebrows from six to 12 months (84.58% vs. 70.29%; p = 0.212) and in eyelashes (83.92% vs. 73.40%; p = 0.313), suggesting better late-stage response compared to tofacitinib.

Conclusion

JAK inhibitors demonstrated efficacy in Jordanian patients with alopecia areata, leading to enhanced SALT scores and noticeable hair regrowth, with baricitinib demonstrating greater improvement in SALT scores compared to tofacitinib.