Impact of Oral JAK Inhibitors on SALT Score Improvement and Adverse Events in Alopecia Areata: A Meta‐Analysis

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Objective This meta‐analysis aimed to systematically evaluate the efficacy and safety of oral Janus kinase (JAK) inhibitors in the treatment of alopecia areata (AA), thereby providing evidence‐based reference for clinical medication. Methods Computerized searches were conducted in PubMed (MEDLINE), Embase, Web of Science, and the Cochrane Library to collect randomized controlled trials (RCTs) on oral JAK inhibitors for AA published from database inception to April 2026. Two reviewers independently screened the literature, extracted data, and evaluated the quality. Meta‐analysis was performed using RevMan software Version 5.4. Results Nine articles (10 studies) were included, involving 924 control and 2493 experimental cases. The results of the meta‐analysis showed that oral JAK inhibitors were significantly superior to placebo in improving the severity of AA. The differences were statistically significant for SALT50 [OR = 6.10, 95% CI (3.94, 9.44)], SALT75 [OR = 5.81, 95% CI (2.73, 12.36)], SALT90 [OR = 7.91, 95% CI (2.44, 25.63)], SALT ≤ 20 [OR = 10.50, 95% CI (5.21, 21.16)], and SALT ≤ 10 [OR = 13.06, 95% CI (4.28, 39.83)] (all p < 0.0001). Significant heterogeneity was observed for SALT90, SALT ≤ 20, and SALT ≤ 10. Subgroup analysis indicated that baricitinib had a stable efficacy; deuruxolitinib showed a dose‐dependent effect, with the high dose (12 mg) demonstrating the strongest effect in achieving near‐complete hair regrowth (SALT ≤ 10) (OR = 118.38); and ritlecitinib was associated with a relatively lower risk of adverse events (AEs) in the safety analysis. Regarding safety, the JAK inhibitor group had a higher incidence of any AEs compared with the control group [OR = 1.32, 95% CI (1.13, 1.56), p = 0.0006], but no statistically significant difference in the incidence of serious AEs (SAEs) was observed between the two groups [OR = 0.99, 95% CI (0.62, 1.58), p = 0.95]. Subgroup analysis suggested differences in the risk of AEs among different drugs: the deuruxolitinib group had a higher risk than the baricitinib group, and the baricitinib group had a higher risk than the ritlecitinib group. Conclusion Oral JAK inhibitors significantly improve SALT scores in patients with AA. The risk of AEs is increased, but most events are mild to moderate, with no significant increase in the risk of serious AEs. However, the efficacy of JAK inhibitors is heterogeneous, which may be related to the specific drug and its dosage. This meta‐analysis only reported odds ratios (ORs) without absolute risk differences and numbers needed to treat and lacked subgroup analysis stratified by baseline disease severity (alopecia totalis/alopecia universalis). In addition, all efficacy comparisons between different JAK inhibitors should be regarded as exploratory rather than definitive conclusions. Clinical treatment should be individualized, and more long‐term follow‐up, head‐to‐head comparative trials, and subgroup analyses stratified by AA severity are needed in the future.

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