JAK Inhibitor Therapy in Alopecia Areata with Latent Hepatitis B Virus or Tuberculosis Infection: A Safety Assessment

Research Hypothesis
This study hypothesizes that JAK inhibitor therapy (ritlecitinib or baricitinib) can be safely administered to patients with moderate-to-severe alopecia areata (AA) who also have latent hepatitis B virus (HBV) infection or stable/resolved tuberculosis (TB), without leading to viral reactivation or disease progression, provided that appropriate monitoring and selective prophylactic measures are implemented.
Data Summary
The dataset comprises clinical data from a retrospective case series of nine patients with AA and comorbid HBV (n=7) or TB (n=2). Data include baseline demographics, SALT (Severity of Alopecia Tool) scores, HBV serology (HBsAg, HBV DNA), liver function tests, TB imaging (chest X-ray or CT), and longitudinal follow-up data over a median of 7 months (range: 3–17 months). Patients were treated with JAK inhibitors, with or without antiviral prophylaxis, and monitored quarterly for safety outcomes.
Notable Findings
No cases of HBV reactivation or TB progression were observed. One patient developed transient liver enzyme elevation, which resolved after drug discontinuation. All patients showed hair regrowth and reduced SALT scores, indicating treatment efficacy. JAK inhibitors demonstrated a favorable safety profile in this high-risk population, even in the absence of universal antiviral prophylaxis.
Data Interpretation and Use
The data suggest that JAK inhibitors may be a viable treatment option for AA patients with controlled HBV or TB infections, supporting a risk-adapted management strategy. The dataset can be used to inform clinical decision-making, guide monitoring protocols, and design future prospective studies in similar populations. Researchers should consider the small sample size and retrospective nature of the data when interpreting results.
Data Collection Methods
Data were collected retrospectively from electronic medical records at a single institution between January 2024 and August 2025. Inclusion criteria included confirmed AA diagnosis, latent HBV or stable TB, and at least 3 months of JAK inhibitor therapy. Safety outcomes were defined as HBV reactivation (≥2 log10 IU/mL increase in HBV DNA) or TB progression (new radiographic lesions or symptoms).
How to Interpret the Data
Virologic stability: HBV DNA levels remained stable or undetectable in all patients.
Radiographic stability: No new or progressive TB lesions were observed.
Liver enzyme elevation: Isolated and reversible, not necessarily indicative of viral reactivation.
Efficacy: SALT score improvements support JAK inhibitor effectiveness in AA.
This dataset provides real-world evidence supporting the cautious use of JAK inhibitors in patients with comorbid infections, emphasizing the importance of tailored monitoring and prophylactic strategies.