Study On The Efficacy And Safety Of Oral JAK Inhibitors In The Treatment Of Alopecia Areata

Background and purpose:Alopecia areata is a hair follicle-specific autoimmune disease.It is a common type of non-scarring alopecia.Moderate to severe alopecia areata affects the appearance of patients,and seriously affects the quality of life and mental health of patients.JAK inhibitor is a new type of small molecule drug for tyrosine kinase.It is currently mainly used to treat rheumatoid arthritis,psoriasis,atopic dermatitis,ulcerative colitis and other diseases,but the research on the treatment of alopecia areata is still In the exploratory stage.Meta analysis is a scientific method used to collect and integrate all relevant research evidence about a research question.This study will conduct an integrated analysis of all currently published clinical studies on the effectiveness and safety of oral JAK inhibitors in the treatment of alopecia areata through meta-analysis,in order to further evaluate and analyze the effectiveness and safety of the drug in the treatment of alopecia areata.Find a safe and effective method to treat alopecia areata,and bring good news to patients with alopecia areata.Methods:Following the proposed inclusion and exclusion criteria,clinical studies of Janus kinase inhibitor therapy for alopecia areata published until March 1,2021 were retrieved and screened in both Chinese and English databases including CBM,CKNI,Wanfang,Cochrane Library,Pub Med,EMBASE,web of science ect,reading the full texts,extracting data,The methodological index for non randomized studies(MINORS)scale or PEDro scale was used to evaluate the quality of the literature,and the software R language version 4.0.3 was used to perform the meta-analysis,sensitivity analysis and publication bias analysis of the data,and the heterogeneity among the results of each study was assessed using the Cochrane Q test(test level wasα=0.1)and combined using I2 to assess the magnitude of heterogeneity.Results:After searching and screening,a total of 21 researches that meet the requirements were obtained,including 19 articles containing Tofacitinib and 3 articles containing Ruxolitinib.The clinical response rate of JAK inhibitors was 80%.Subgroup analysis showed that tofacitinib was 79% and ruxolitinib was 84%;The reduction of salt score by more than 50% was defined as partial response,and the partial response rate of JAK inhibitor treatment was 61%.Subgroup analysis showed that tofacitinib was 57%,and ruxolitinib was 79%;The reduction of salt score by more than 90% was defined as basic response / complete response.The basic response rate of JAK inhibitor treatment was 27%.Subgroup analysis showed that tofacitinib was 24%,and ruxolitinib was 42%.No serious adverse reactions have been reported in all the included literature.Common adverse reactions include upper respiratory tract infection(25%),elevated liver enzymes(11%),acne(14%),headache(9%),and elevated blood lipids(16%),urinary tract infection(7%),defecation habit change(7%)(mostly diarrhea),and weight gain(5%).Conclusion:JAK inhibitors have significant efficacy in the treatment of moderate to severe alopecia areata,but they have a high recurrence rate after drug withdrawal and unknown safety.More clinical studies are needed to verify their efficacy and safety in the treatment of alopecia areata.