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.目前，儿童斑秃（alopecia areata, AA）尚无统一的诊疗共识。美国食品药品监督管理局（Food and Drug Administration, FDA）批准用于青少年的利特昔替尼（ritlecitinib），以及其他Janus激酶抑制剂（Janus kinase inhibitors, JAKis）的超适应症使用，均展现出令人鼓舞的应用前景。然而，现有相关研究数据仍较为有限。本研究对Janus激酶抑制剂用于儿童斑秃患者的治疗结局与不良反应开展了系统综述，纳入了来自至少10个国家、年龄介于1.1岁至18岁的283例患者。尽管本研究存在样本量较小、可能存在回忆偏倚等局限性，但研究结果显示，Janus激酶抑制剂对于≤18岁的斑秃年轻患者具有良好的治疗效果与耐受性，不过复发仍是需要关注的问题。值得注意的是，本研究发现脂质代谢异常为最高发的不良事件风险类型，且整体不良反应较为轻微。鉴于美国食品药品监督管理局已针对成人使用Janus激酶抑制剂相关的心血管事件风险升高发出警告，我们认为儿童患者中脂质代谢紊乱与心脏不良事件之间的关联值得进一步深入研究。