A Study on Alopecia Areata Treatments: What Is Being Discussed About Cardiovascular Issues?

Q1. Are JAK inhibitors really effective for treating alopecia areata?

Yes, recently JAK inhibitors (Janus kinase inhibitors) have become an important turning point in the treatment of severe alopecia areata.

Whereas conventional steroids or immunosuppressants had limited effectiveness and many long-term side effects, JAK inhibitors help follicle cells recover by suppressing the excessive attack of immune cells¹.

In actual clinical practice, baricitinib and ritlecitinib have been approved and are being used in Korea as well, greatly increasing the possibility of hair regrowth.

Q2. Does using JAK inhibitors increase the risk of cardiovascular disease?

Many patients ask, “I heard it puts strain on the heart—will I be okay?” In fact, studies in patients with rheumatoid arthritis have reported that JAK inhibitors increase the risk of myocardial infarction and stroke (MACE), pulmonary embolism and deep vein thrombosis (VTE), which is why they carry a black box warning⁴.

However, patients with alopecia areata are often younger on average and have fewer cardiovascular risk factors.

A recent multicenter cohort study confirmed that JAK inhibitors did not significantly increase cardiovascular events⁵.

Q3. Then how do they compare with conventional immunosuppressants?

In an analysis comparing 1,832 patients with severe alopecia areata, the group that used traditional immunosuppressants (steroids, methotrexate, etc.) had a 2.93 times higher risk of myocardial infarction and stroke, and a 3.63 times higher risk of thromboembolism.

By contrast, the patient group using JAK inhibitors showed a lower risk⁵.

In other words, this is evidence that JAK inhibitors may actually be the better option from a safety standpoint.

Q4. Which JAK inhibitors can be used in Korea?

Source - Hit News

Baricitinib

Source - Health O

Ritlecitinib

Currently in Korea, baricitinib (Baricitinib, Olumiant) and ritlecitinib (Ritlecitinib, Litfulo) have been approved and are being used to treat patients with alopecia areata². Deuruxolitinib (Deuruxolitinib, Leqselvi) has been approved in the United States, but it has not yet been introduced in Korea.

Q5. Is it safe to use them long term?

Not all the answers are in yet.

This study analyzed follow-up data for an average of about two years, so long-term safety will require future prospective studies⁵.

However, based on the evidence so far, they show a better safety profile than conventional immunosuppressants, so in clinical practice they can be recommended to patients with increasing confidence.

Questions about cardiovascular safety

Summary table

Question	Summary of answer
Are JAK inhibitors effective?	They help hair regrowth by suppressing follicle immunity¹
Is there a cardiovascular disease risk?	No significant increase in patients with alopecia areata⁵
Compared with conventional immunosuppressants?	The immunosuppressant group had a 2.93× higher MACE risk and a 3.63× higher VTE risk⁵
Which drugs are available in Korea?	Baricitinib and ritlecitinib approved²
Is long-term safety established?	Positive through 2-year data, but long-term studies are needed⁵

Now it's time for hair growth, this was Kim Jin-o.

May new hair be born and grow (必生新毛).

References

1. Sechi A, Song J, Dell'Antonia M, et al. (2023). Adverse events in patients treated with Jak‐inhibitors for alopecia areata: A systematic review. Journal of the European Academy of Dermatology and Venereology, 37(8):1535-1546.

2. Dahabreh D, Jung S, Renert-Yuval Y, et al. (2023). Alopecia Areata: Current Treatments and New Directions. American Journal of Clinical Dermatology, 24(6):895-912.

3. Kotyla PJ, Engelmann M, Giemza-Stokłosa J, et al. (2021). Thromboembolic Adverse Drug Reactions in Janus Kinase (JAK) Inhibitors: Does the Inhibitor Specificity Play a Role? International Journal of Molecular Sciences, 22(5).

4. Misra DP, Pande G, Agarwal V. (2023). Cardiovascular risks associated with Janus kinase inhibitors: peering outside the black box. Clinical Rheumatology, 42(2):621-632.

5. Islam RK, Levine J, Maltese A, et al. (2025). Cardiovascular Risk of JAK Inhibitors in Severe Alopecia Areata: A Multicenter Cohort Study. Clinical and Experimental Dermatology.

[In accordance with Article 56, Paragraph 1 of the Medical Service Act, this post is written directly by a plastic surgery specialist for informational purposes. Hair transplant surgery and treatment may have side effects, and you should make a careful decision after consulting with a specialist.]

Written by: New Hair Plastic Surgery Kim Jin-o (Public Relations Director, Korean Association of Plastic Surgeons / Academic Director, Korean Society of Laser Dermatology and Hair Restoration)