Real-World Efficacy and Safety of Upadacitinib for the Treatment Alopecia Areata: A Systematic Review and Meta-Analysis
Description
Our dataset comprises 33 studies including 136 patients with alopecia areata (AA) treated with upadacitinib across case reports, case series, and cohort studies. Patients had a mean age of 27.8 years (55.1% female), with predominantly severe disease (baseline SALT 77.1). Treatment regimens varied, with both low-dose (≤15 mg/day) and high-dose (≥30 mg/day) upadacitinib administered for an average of 24 weeks. Analyses incorporated subgroups by age, dosing, and prior JAK inhibitor exposure. The primary outcome was change in SALT score, complemented by achievement of thresholds (SALT50, SALT75, SALT90, SALT100, SALT≤20). Overall, upadacitinib led to a substantial pooled SALT reduction (−68.5), with comparable efficacy across age groups, dosing regimens, and prior JAKi exposure. In patients with severe AA, pooled outcomes showed a −79.9 mean reduction and high rates of clinically meaningful responses (SALT50: 94%; SALT≤20: 89%). In the 15 mg/day subgroup, improvements were more modest, with a −60.5 mean reduction and 24% complete regrowth (SALT100). Adverse events were reported in about one-third of patients, all mild and not requiring discontinuation, supporting an overall favorable safety profile.