Choosing Among Approved JAK Inhibitors: Baricitinib, Ritlecitinib, and Deuruxolitinib

The approval of 3 JAK inhibitors for alopecia areata-baricitinib, ritlecitinib, and deuruxolitinib--represents a transformational moment in a field that, until very recently, had no reliable disease-modifying systemic options. For dermatologists who trained and practiced during the decades when patients with severe or progressive AA had little to offer beyond intralesional injections, topical agents, and off-label immunosuppressants with modest and unpredictable efficacy, the arrival of 3 FDA-approved oral agents is genuinely historic. Patients who 20 to 30 years ago could travel internationally seeking any treatment that reliably restored hair can now access effective therapy through a standard office visit and a prescription. Framing the current moment in those terms-as the beginning of a new treatment era rather than a routine expansion of the formulary— helps both clinicians and patients appreciate what is now possible.

Practical differentiation among the 3 agents is achievable even in the absence of head-to-head comparative trials. Ritlecitinib is approved for adolescents aged 12 and older, making it the appropriate first consideration when earlier intervention in younger patients is the clinical priority. Once-daily oral dosing, available with certain agents, may meaningfully improve adherence in patients managing complex polypharmacy regimens or those who express a strong preference for simplicity. Renal and hepatic dosing adjustments vary across the 3 drugs and must be evaluated in the context of each patient's comorbidity profile before a prescription is written. When an initial agent does not produce adequate hair regrowth after a sufficient trial period, switching to a different JAK inhibitor targeting a distinct molecular mechanism remains a reasonable and clinically supported strategy. The absence of head-to-head data does not mean the drugs are interchangeable-it means that individual patient response must guide sequencing decisions.

In this segment, Nader Aboul-Fettouh, MD, double board-certified dermatologist and fellowship-trained Mohs Micrographic Surgeon and founder and managing director of Blue Ribbon Dermatology in the Dallas area, shares how he navigates the agent-selection conversation with patients newly eligible for systemic therapy. He explains how he weighs age, comorbidities, dosing preferences, and compliance considerations in making an initial recommendation, while conveying to patients that treatment for AA is an iterative process—with multiple viable, FDA-approved options-rather than a single high-stakes decision.