The First Affilated Hospital of Dalian Medical University, Dalian, Liaoning, 116000, China.
Department of Epidemiology, Dalian Medical University, Dalian, Liaoning, 116044, China.
Arch Dermatol Res. 2024 Jul 23;316(7):483. doi: 10.1007/s00403-024-03177-9.
Severe alopecia areata (AA) is a nonscarring hair loss for immune disorder and SALT score ≥ 50%. The guidelines for managing patients with severe AA suggest treatments: systemic steroids, JAK inhibitors, and contact immunotherapy. However, there is a lack of evidence indicating the superiority of one treatment over another. Therefore, this study aimed to identify the most effective treatment for severe AA through network meta-analysis. Following the PRISMA guidelines, we conducted a network meta-analysis. The literature search was retrieved across four databases. The Cochrane 5.1 risk of bias assessment tool and ROBINS-I tool assessed quality of the included studies. Subsequently, efficacy and safety comparisons among the three treatments were conducted using Stata 14.0 on account of the frequency method. The SUCRA rank indicated that oral dexamethasone (95.9%) > diphenylcyclopropenone(DPCP) (74.5%) > oral ritlecitinib (62.6%) > oral baricitinib (46.9%) > squaric acid dibutyl ester(SADBE) (20.1%) > placebo (0.0%) from high to low in the aspect of improving efficacy. As for safety, placebo(88.4%) > oral ritlecitinib (86.5%) > oral baricitinib (62.1%) > SADBE (37.0%) > oral dexamethasone(22.3%) > DPCP(3.8%) in the aspect of decreasing adverse events. Oral dexamethasone and DPCP showed superior efficacy compared to oral ritlecitinib and oral baricitinib. However, in terms of safety, oral ritlecitinib was preferable. Some adverse events associated with oral dexamethasone and DPCP were intolerable to patients, whereas those related to oral ritlecitinib and oral baricitinib were more manageable. Overall, ritlecitinib and baricitinib remain promising drugs in the future treatment of severe AA.
严重型斑秃（AA）是一种非瘢痕性脱发，由免疫紊乱引起，SALT 评分≥50%。严重型 AA 患者的管理指南建议采用以下治疗方法：全身皮质类固醇、JAK 抑制剂和接触免疫疗法。然而，目前缺乏一种治疗方法优于其他方法的证据。因此，本研究旨在通过网络荟萃分析确定治疗严重型 AA 最有效的方法。本研究遵循 PRISMA 指南进行网络荟萃分析。文献检索在四个数据库中进行。使用 Cochrane 5.1 偏倚风险评估工具和 ROBINS-I 工具评估纳入研究的质量。随后，使用 Stata 14.0 基于频数法比较三种治疗方法的疗效和安全性。SUCRA 排名表明，口服地塞米松（95.9%）>二苯环丙烯酮（DPCP）（74.5%）>口服利替尼（62.6%）>口服巴瑞替尼（46.9%）>丁二酸二丁酯（SADBE）（20.1%）>安慰剂（0.0%），提示在改善疗效方面，从高到低依次为口服地塞米松、DPCP、口服利替尼、口服巴瑞替尼、SADBE 和安慰剂。在降低不良反应方面，安慰剂（88.4%）>口服利替尼（86.5%）>口服巴瑞替尼（62.1%）>SADBE（37.0%）>口服地塞米松（22.3%）>DPCP（3.8%），提示在安全性方面，从高到低依次为安慰剂、口服利替尼、口服巴瑞替尼、SADBE、口服地塞米松和 DPCP。与口服利替尼和口服巴瑞替尼相比，口服地塞米松和 DPCP 具有更好的疗效。然而，在安全性方面，口服利替尼更具优势。一些与口服地塞米松和 DPCP 相关的不良反应令患者难以耐受，而与口服利替尼和口服巴瑞替尼相关的不良反应则更容易管理。总体而言，利替尼和巴瑞替尼仍然是未来治疗严重型 AA 的有前途的药物。
