DataSheet_1_Efficacy and safety of different JAK inhibitors in the treatment of alopecia areata: a network meta-analysis.docx

BackgroundAlopecia areata (AA) is an immune disease characterized by non-scarring hair loss. With the widespread application of JAK inhibitors in immune-related diseases, attention is being given to their role in the treatment of AA. However, it is unclear which JAK inhibitors have a satisfactory or positive effect on AA. This network meta-analysis aimed to compare the efficacy and safety of different JAK inhibitors in the treatment of AA.
MethodsThe network meta-analysis was performed according to the PRISMA guidelines. We included randomized controlled trials as well as a small number of cohort studies. The differences in efficacy and safety between the treatment and control groups were compared.
ResultsFive randomized controlled trials, two retrospective studies, and two prospective studies involving 1689 patients were included in this network meta-analysis. In terms of efficacy, oral baricitinib and ruxolitinib significantly improved the response rate of patients compared to placebo [MD = 8.44, 95% CI (3.63, 19.63)] and [MD = 6.94, 95% CI, (1.72, 28.05)],respectively. Oral baricitinib treatment significantly improved the response rate compared to non-oral JAK inhibitor treatment [MD=7.56, 95% CI (1.32,43.36)]. Oral baricitinib, tofacitinib, and ruxolitinib treatments significantly improved the complete response rate compared to placebo [MD = 12.21, 95% CI (3.41, 43.79)], [MD = 10.16, 95% CI (1.02, 101.54)], and [MD = 9.79, 95% CI, (1.29, 74.27)], respectively. In terms of safety, oral baricitinib, tofacitinib, and ruxolitinib treatments significantly reduced treatment-emergent adverse event rates compared with conventional steroid treatment [MD = 0.08, 95% CI (0.02, 0.42)], [MD = 0.14, 95% CI (0.04, 0.55)], and [MD = 0.35, 95% CI, (0.14, 0.88)], respectively.
ConclusionOral baricitinib and ruxolitinib are excellent options for the treatment of AA owing to their good efficacy and safety profiles. In contrast, non-oral JAK inhibitors do not appear to have satisfactory efficacy in treating AA. However, further studies are required to verify the optimal dose of JAK inhibitors for AA therapy.

背景：斑秃（Alopecia areata, AA）是一种以非瘢痕性脱发为特征的免疫性疾病。随着JAK抑制剂在免疫相关疾病中的广泛应用，其在斑秃治疗中的作用日益受到关注。然而，目前尚不明确哪些JAK抑制剂对斑秃具有满意或积极的治疗效果。本网状meta分析旨在比较不同JAK抑制剂治疗斑秃的疗效与安全性。
方法：本网状meta分析严格遵循PRISMA指南开展。研究纳入随机对照试验及少量队列研究，对比各治疗组与对照组在疗效与安全性上的差异。
结果：本网状meta分析共纳入5项随机对照试验、2项回顾性研究及2项前瞻性研究，涉及1689例患者。在疗效维度，与安慰剂相比，口服巴瑞替尼（baricitinib）与鲁索替尼（ruxolitinib）可显著提升患者的治疗应答率[均差(MD)=8.44，95%置信区间(CI)=(3.63, 19.63)]与[MD=6.94，95%CI=(1.72, 28.05)]。相较于非口服JAK抑制剂治疗，口服巴瑞替尼治疗可显著提升治疗应答率[MD=7.56，95%CI=(1.32, 43.36)]。与安慰剂相比，口服巴瑞替尼、托法替布（tofacitinib）与鲁索替尼均可显著提升完全应答率[MD=12.21，95%CI=(3.41, 43.79)]、[MD=10.16，95%CI=(1.02, 101.54)]与[MD=9.79，95%CI=(1.29, 74.27)]。在安全性维度，与常规糖皮质激素治疗相比，口服巴瑞替尼、托法替布与鲁索替尼均可显著降低治疗期间出现的不良事件发生率[MD=0.08，95%CI=(0.02, 0.42)]、[MD=0.14，95%CI=(0.04, 0.55)]与[MD=0.35，95%CI=(0.14, 0.88)]。
结论：鉴于良好的疗效与安全性特征，口服巴瑞替尼与鲁索替尼是斑秃治疗的优质选择。与之相对，非口服JAK抑制剂在斑秃治疗中似乎未展现出满意的疗效。不过，仍需开展进一步研究以明确JAK抑制剂用于斑秃治疗的最优剂量。