Use of Janus kinase inhibitors in patients aged ≤18 years with alopecia areata: A systematic review and meta-analysis

Currently, no consensus exists for managing pediatric alopecia areata (AA), but the Food and Drug Administration (FDA)-approved ritlecitinib for adolescents, along with the off-label use of other Janus kinase inhibitors (JAKis) present encouraging possibilities. However, the available data are limited. In this study, we systematically reviewed treatment outcomes and adverse effects of JAKis in pediatric AA patients, involving 283 patients aged 1.1 to 18 years from at least 10 countries. Despite limitations including small sample sizes and possible recall bias, our findings demonstrate that JAKis are useful and well tolerated for AA in young patients (≤18 years), though relapse remains a concern. Notably, we found that the highest risk was lipid metabolism abnormalities, while adverse events were mild.Since FDA has warned about increased risks of cardiovascular events associated with JAKis in adults, we suggest that the relationship between lipid dysregulation and cardiac incidents in pediatric patients warrants further investigation.