Alopecia Areata: JAK Drugs, Steroids, Minoxidil & Funding Evidence

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Key takeaways
  • Alopecia areata is an autoimmune condition that causes non-scarring hair loss. It can appear as a few round patches, as total scalp loss (alopecia totalis) or as whole-body loss (alopecia universalis). A UK primary-care cohort estimated that about 2 in 100 people will develop it in their lifetime (Thompson et al., BJD 2024).
  • Three oral JAK inhibitors now have US approval for severe disease: baricitinib (June 2022), ritlecitinib (June 2023) and deuruxolitinib (July 2024). The baricitinib trials were funded by Eli Lilly under licence from Incyte (BRAVE, NEJM 2022). The ritlecitinib trial is labelled as Pfizer-funded (ALLEGRO, Lancet 2023).
  • In the largest pooled review, the Cochrane network meta-analysis, baricitinib was the treatment with high-certainty evidence of increased hair regrowth. The estimate was RR 8.49 (95% CI 4.70 to 15.34) for regrowth of at least 75%, rated high certainty (Mateos-Haro et al., Cochrane 2023). Cochrane rated the evidence for topical minoxidil, contact immunotherapy and intralesional steroids as very low certainty.
  • Benefit appears to depend on continued treatment. In BRAVE-AA1, 80% of responders who stopped baricitinib had lost benefit by week 152, compared with 7% who continued (JAMA Dermatology 2024).
  • Both JAK drugs carry a boxed warning for serious infections, mortality, malignancy, major adverse cardiovascular events and thrombosis (Litfulo label; Olumiant label).
  • UK decisions diverge. NICE did not recommend baricitinib, citing uncertain cost-effectiveness (TA926). It recommended ritlecitinib in March 2024, but only if the company supplies it under a confidential discount (TA958).
  • Money trail: Eli Lilly and Pfizer funded the pivotal JAK trials. Pfizer funded a UK epidemiology study whose authors include Pfizer employees (Thompson 2024). The US charity NAAF thanks Eli Lilly, Pfizer and Sun Pharma for supporting its programmes (NAAF Annual Report 2023). The UK charity Alopecia UK reported a Pfizer-funded study (Alopecia UK 2022).
  • Evidence grade: Strong for baricitinib regrowth while treated, with industry-sponsored trials. Moderate for ritlecitinib and deuruxolitinib, which rest on manufacturer-funded trials. Insufficient for steroids, DPCP and minoxidil in severe disease. Risk for infection, malignancy and thrombosis on JAK treatment.

Independent evidence review · Prescription medicine

For severe alopecia areata, the best-supported treatment is a daily JAK inhibitor, and the strongest evidence is for baricitinib. Regrowth is common while people keep taking it, but hair is usually lost again after stopping. Ritlecitinib and deuruxolitinib also have approvals. Ritlecitinib's pivotal trial was sponsored by Pfizer, and deuruxolitinib's trials were run under Concert Pharmaceuticals, which Sun Pharma acquired in 2023. Steroid injections, contact immunotherapy (DPCP) and minoxidil have older or smaller evidence. Our confidence: high that JAK inhibitors cause regrowth in severe disease during treatment; moderate that the benefit is lost after stopping; low for DPCP and minoxidil.

Best evidence for baricitinib (RR 8.49 for at least 75% regrowth vs placebo, high-certainty Cochrane evidence) in severe disease
Main risks serious infections including TB, malignancy, thrombosis, cardiovascular events; acne and lab changes; local reactions to DPCP
Key rule JAK treatment needs a specialist who checks for infection and latent TB first, and regrowth is lost in most people who stop
Safety first, and when to get clinical help
See a GP promptly if hair loss starts suddenly, spreads quickly, or comes with scalp redness, scaling, pain, or tiredness or weight loss. NHS inform recommends contacting your GP practice for sudden or unexpected hair loss (NHS inform). Scarring hair loss needs urgent specialist review, because early treatment can help prevent permanent follicle loss (BAD patient leaflet). Clinicians: before starting a JAK inhibitor, test for latent tuberculosis, check blood counts and screen for infection. Interrupt treatment during any serious infection (Litfulo label; Olumiant label). Do not start or stop any of these drugs without specialist input.

Table of contents

Evidence summary

Claim Evidence Source Funding / conflict Strength
Baricitinib regrows hair in severe alopecia areata BRAVE-AA1 (n=654) and BRAVE-AA2 (n=546), adults with SALT score of 50 or more. SALT 20 or less at week 36: 38.8% with 4 mg, 22.8% with 2 mg and 6.2% with placebo (AA1). Difference for 4 mg vs placebo 32.6 points. In AA2, 35.9%, 19.4% and 3.3%. King et al., NEJM 2022 Funded by Eli Lilly under licence from Incyte, per the abstract. Tier 4. Strong
Baricitinib increases hair regrowth in pooled trials Cochrane network meta-analysis: RR 8.49 (4.70 to 15.34) for regrowth of at least 75%, 1,200 participants, 2 studies, high certainty. Mateos-Haro et al., Cochrane 2023 Cochrane review funded by the UK National Institute for Health Research (NIHR, grant 14/178/29). Tier 2. Strong
Ritlecitinib regrows hair in adults and adolescents ALLEGRO (n=718, age 12 and over). SALT 20 or less at week 24: 31% with 200 mg loading plus 50 mg, 23% with 50 mg, and 2% with placebo. Difference for the top arm 29.1 points. King et al., Lancet 2023 The abstract ends with the funder, Pfizer. Tier 4. Moderate
Deuruxolitinib regrows hair in adults FDA approval in July 2024 for severe disease in adults, based on phase 3 trials. The developer is Sun Pharmaceutical Industries. We did not open the trial reports. Deuruxolitinib approval review, 2026 Sun Pharma acquired the trial sponsor, Concert Pharmaceuticals, in 2023. Trial funder not confirmed. Tier 4. Trial efficacy not assessed here. Not assessed
Hair is lost again after JAK treatment stops BRAVE-AA1 randomised withdrawal (154 responders). By week 152, 80% of those switched to placebo had lost benefit, against 7% who continued baricitinib. Most patients regained response after retreatment (21 of 24 on 4 mg). BRAVE-AA1 withdrawal, JAMA Dermatology 2024 Four authors are Eli Lilly employees by affiliation. Lead author reports personal fees from Eli Lilly, Sun and Pfizer. Tier 4. Moderate
Contact immunotherapy with DPCP regrows hair Meta-analysis of 45 studies (2,227 patients): any regrowth 65.5%, complete regrowth 32.3%. Recurrence 38.3% with maintenance and 49.0% without. Cochrane's single placebo-controlled trial: RR 1.16 (0.79 to 1.71), very low certainty. Lee et al., JAMA Dermatology 2018 No conflicts reported; funding line not seen in the abstract. Pooled studies are mostly small and uncontrolled. Tier 2. Weak
Topical minoxidil regrows hair Cochrane: 1% and 2% minoxidil vs placebo, RR 2.31 (1.34 to 3.96), 202 participants, 2 studies, very low certainty. A 2024 review found response of 82% with 5% topical minoxidil and 58% with lower concentrations, in 13 studies and 372 patients. Majewski et al., J Clin Med 2024 No grant is listed for the 2024 review in Europe PMC. The 1987 placebo trials of 3% minoxidil were not checked for funding. Tier 1 for the 2024 review. Weak
Intralesional steroid injections regrow hair Cochrane: one trial of betamethasone or triamcinolone vs placebo, 231 participants, RR 13.84 (0.87 to 219.76), very low certainty. Confidence interval includes no effect. Mateos-Haro et al., Cochrane 2023 Cochrane funded by NIHR. Single underlying trial. Tier 2. Insufficient
JAK inhibitors raise serious risks Boxed warnings for serious infections (including TB), mortality, malignancy, MACE and thrombosis. Acne, raised creatine kinase and raised LDL and HDL cholesterol were more common with baricitinib than placebo in BRAVE. Litfulo label; BRAVE, NEJM 2022 Regulator labels built on sponsor trial data. Tier 1 for the label; trials Tier 4. Risk
Ritlecitinib adverse events vs placebo Meta-analysis of controlled trials: more headache, acne and nasopharyngitis on ritlecitinib, with no significant difference in serious adverse events. Alfahl et al., J Clin Med 2025 No conflicts declared by the authors. Pools controlled trials, including manufacturer-sponsored ones. Tier 2. Risk (lower)

Independent evidence and credibility scorecard

Independence tiers: 1 = regulator, government body or independent review with no declared industry funding for the work; 2 = academic or Cochrane team, or a professional body, with declared industry ties or unverified funding; 3 = patient charity or advocacy group that takes sponsorship from manufacturers; 4 = manufacturer-funded or manufacturer-authored. Credibility runs from A (highest) to D.

Source Who funds it Country Independence tier (1–4) Credibility (A–D) Why it would tell the truth / residual bias
NICE technology appraisals TA926 and TA958 UK government health system (NHS England and the devolved nations use NICE guidance) UK 1 A Legal duty to assess cost-effectiveness for NHS spending. Residual bias: the ritlecitinib recommendation depends on a confidential company discount.
FDA and EMA product labels (Olumiant, Litfulo, Litfulo SmPC) Public regulators; labels are written from sponsor submissions US; EU 1 A Regulators face legal accountability for safety. Residual bias: approvals rest on company-run trials, and labels use company-supplied data.
Cochrane network meta-analysis (Mateos-Haro et al., 2023) Funded by the UK National Institute for Health Research (NIHR), which is the largest single funder of Cochrane Skin. Some authors declare payments from pharmaceutical companies, including Lilly and Pfizer. International review group; funder UK 2 B Subscription and reputation depend on accuracy, and the method is pre-registered and graded. Residual bias: most included trials are industry-funded, and the review cannot correct that.
BAD living guideline for alopecia areata (2025) British Association of Dermatologists; the guideline states it follows the BAD policy on declared interests UK 2 B Professional standing depends on guideline quality. Residual bias: the lead author declared fees from Pfizer and Lilly, paid to his NHS trust, and a role on NICE's baricitinib panel.
Lee et al., DPCP meta-analysis (JAMA Dermatology 2018) No conflicts reported; funding line not seen US (journal); authors' country not verified 2 B Peer-reviewed meta-analysis with standard criteria. Residual bias: pooled studies are small and mostly uncontrolled, and funding could not be checked.
Majewski et al., minoxidil review (J Clin Med 2024) No grant listed (Europe PMC) Not verified (MDPI journal) 1 B No funder to protect. Residual bias: small, heterogeneous set of 13 studies, with sample sizes of 372 participants.
Thompson et al., UK lifetime incidence (BJD 2024) Grant from Pfizer (Europe PMC grant record). Three of six authors are Pfizer Ltd employees, per the abstract's competing-interests statement. UK 4 C Uses a national primary-care database, which limits selection. Residual bias: manufacturer-funded and co-authored by manufacturer staff, so the framing may favour awareness of the disease.
King et al., BRAVE-AA1 and AA2 (NEJM 2022) Eli Lilly, under licence from Incyte US (sponsor); Incyte HQ US 4 D Peer-reviewed and registered, with strong placebo control. Residual bias: sponsor-run trials; the sponsor is Lilly and the full disclosure statement was not reached.
BRAVE-AA1 withdrawal (JAMA Dermatology 2024) Four authors are Eli Lilly employees by affiliation; the lead author reports personal fees from Eli Lilly, Sun and Pfizer. US 4 D Shows the drug's loss-of-benefit pattern in a randomised design. Residual bias: industry authors and a company-run trial.
King et al., ALLEGRO (Lancet 2023) Pfizer US (sponsor) 4 D Large, multicentre, registered trial. Residual bias: manufacturer-sponsored and manufacturer-analysed; the Lancet record names the sponsor as Pfizer.
NAAF, National Alopecia Areata Foundation (2023 annual report) Donors, fundraising and named pharmaceutical sponsors (Eli Lilly, Pfizer, Sun Pharma) US 3 C Patient-facing charity with a donor-accountability duty. Residual bias: its support programmes are sponsored by companies that sell alopecia treatments.
Alopecia UK (2022 review and Pfizer UK disclosure) Pfizer-funded study; Pfizer UK report lists a research grant to Alopecia UK UK 3 C Patient charity with a strong public-benefit mission. Residual bias: a company-funded research grant creates a conflict on the economic-burden message.

Sources cluster in the United States (the FDA, most trials, the NAAF) and the United Kingdom (NICE, the BAD, Cochrane funding, the UK cohort). Their verdicts reflect two national lenses: the US accepted JAK approvals, while NICE rejected baricitinib on cost. Convergence is strongest where a UK regulator and the Cochrane review agree: JAK inhibitors work in severe disease, and the effect depends on continued treatment.

What alopecia areata is, and who gets it

Alopecia areata is a non-scarring hair loss condition. It can affect the scalp, eyebrows, eyelashes, beard and body hair (NHS inform). It is usually classed by extent. Patchy disease covers a few round areas. Alopecia totalis is complete scalp hair loss. Alopecia universalis is complete loss of scalp, facial and body hair (BAD patient leaflet). Trials of severe disease usually define it as a SALT score of 50 or more, meaning at least half the scalp is lost (BRAVE, NEJM 2022).

In a UK primary-care cohort, lifetime incidence was about 2 in 100. The overall figure is 2.11%, 5.87% for people of Asian ethnicity and 1.7% for White ethnicity (Thompson et al., 2024). That study was funded by Pfizer. Its database design makes it a useful population count, but the framing of burden is shaped by a manufacturer-funded team.

Other forms and legal status

  • Ritlecitinib is recommended by NICE, within its marketing authorisation, for severe disease in people aged 12 and over, but only under a commercial arrangement (NICE TA958).
  • Baricitinib is licensed in the US for severe alopecia areata in adults and, per Lilly's September 2026 announcement, in people aged 12 and over (the label text itself was not opened). NICE does not recommend it for NHS use in adults (TA926).
  • Ritlecitinib is approved by the European Commission for adults and adolescents aged 12 and older with severe disease (EMA product information).

How it works

Alopecia areata is autoimmune. Immune cells attack hair follicles, which then stop producing hair. Hair often grows back, but the cycle can repeat (NHS inform).

  • Baricitinib is an oral inhibitor of Janus kinases 1 and 2. It is meant to interrupt the signalling that the trial authors link to the disease (BRAVE, NEJM 2022). Baricitinib was discovered by Incyte and licensed to Eli Lilly (Wikipedia summary).
  • Ritlecitinib is an oral JAK3 and TEC-family kinase inhibitor (ALLEGRO, Lancet 2023). It is classed as a Pfizer drug (Wikipedia summary).
  • Contact immunotherapy (DPCP or squaric acid) deliberately sensitises the skin to a chemical. It is thought to divert the immune attack on the follicles. The mechanism is not fully understood (Cochrane 2023).
  • Minoxidil is a topical hair growth stimulant. Its effect on the immune infiltrate is inconsistent: a 1992 randomised trial of 5% minoxidil found no change in perifollicular lymphocytes, (Khoury et al., 1992).

What is proven in humans: JAK inhibitors reduce hair loss in trials. What is not proven: why some people respond and others do not. Laboratory and animal work is not enough to settle the mechanism for steroids or minoxidil in this condition.

What works and what does not

Treatment Evidence in severe or extensive disease Verdict
Baricitinib, 2 mg or 4 mg daily Two placebo-controlled RCTs. High-certainty Cochrane evidence for regrowth of at least 75%. Works while taken
Ritlecitinib, 50 mg daily (after loading) One large RCT (n=718), industry-funded. Pooled controlled-trial meta-analysis confirms a SALT reduction. Works while taken
Deuruxolitinib, 8 mg tablet Approved in adults in July 2024 at 8 mg tablets; trial details not checked here. Approved; evidence not checked
Contact immunotherapy (DPCP) Meta-analysis of 45 studies with 65.5% any regrowth, but mostly uncontrolled. One placebo-controlled trial with very low certainty. Mixed
Topical minoxidil 5% Small placebo-controlled trials in 1980s; 2024 review of 13 studies. Cochrane: very low certainty. Mixed
Intralesional betamethasone or triamcinolone One placebo-controlled trial (n=231). Estimate very imprecise. Insufficient
Oral prednisolone or cyclosporine Two small trials (n=79). Cochrane: very low certainty, confidence interval includes no effect. Insufficient
Natural regrowth without treatment BAD leaflet: complete regrowth within a year for about 4 in 5 people, much less often with extensive loss. Common in mild disease; less likely with extensive loss

Benefits by claim

Do JAK inhibitors regrow hair?

Yes, in severe disease while treatment continues. In BRAVE-AA1, 38.8% of people on 4 mg baricitinib reached a SALT score of 20 or less at week 36, compared with 6.2% on placebo (King et al., NEJM 2022). In the pooled Cochrane analysis, baricitinib increased regrowth of at least 75% with high certainty (Cochrane 2023). Both trials were funded by Eli Lilly under licence from Incyte. Regrowth was defined by SALT scores, which measure scalp coverage and do not capture quality of life.

Ritlecitinib showed a difference from placebo at week 24. In the top-performing arm, 31% reached a SALT score of 20 or less, against 2% on placebo (King et al., Lancet 2023). A 2025 meta-analysis of controlled trials found a significant SALT reduction at weeks 12 and 24 (Alfahl et al., 2025).

Does the NHS fund JAK inhibitors?

Not always. NICE does not recommend baricitinib for NHS use in adults, saying the trials show regrowth but no meaningful gain in most quality-of-life measures, and that cost-effectiveness is uncertain (TA926). NICE recommends ritlecitinib, but only if the company provides it under a confidential arrangement (TA958). Private prescription options were not reviewed here.

Do steroid injections work?

The evidence is weak. The Cochrane review found one placebo-controlled trial of intralesional betamethasone or triamcinolone (n=231). The effect estimate was RR 13.84 with a 95% CI from 0.87 to 219.76, which is very imprecise (Cochrane 2023). Injections are often used for small patches.

Does DPCP (contact immunotherapy) work?

The evidence is mixed. A meta-analysis of 45 studies with 2,227 patients found any hair regrowth in 65.5% and complete regrowth in 32.3%. Any regrowth was 74.6% in patchy disease and 54.5% in totalis or universalis disease. Extent of 50% or more, atopic history and nail involvement were linked to poorer results (Lee et al., JAMA Dermatology 2018). These are pooled, mostly uncontrolled studies. The Cochrane review found one placebo-controlled DPCP trial with RR 1.16 (0.79 to 1.71), which is very uncertain (Cochrane 2023).

Does minoxidil work?

The evidence is weak and inconsistent. Cochrane found RR 2.31 (1.34 to 3.96) for 1% and 2% minoxidil vs placebo across two studies with 202 participants, but rated the evidence very low (Cochrane 2023). A 2024 review of 13 studies with 372 patients reported response of 82% with 5% topical minoxidil and 58% with lower concentrations. (Majewski et al., 2024). Early placebo-controlled trials of 3% minoxidil enrolled only 30 people (Price, 1987). Their funding was not checked.

Prognosis and relapse

Many people regrow hair without treatment. The BAD patient leaflet says that, for about 4 in 5 people, complete regrowth occurs within a year without treatment. It says people with more than half their hair lost, or complete loss, have only about a 1 in 10 chance of full recovery (BAD patient leaflet). The BAD's 2012 guideline gives a lower 34 to 50% recovery within a year in specialist referral centres, and traces the 80% figure to a Japanese study of people with a few small patches (BAD 2012 guideline).

Relapse is the main issue with JAK treatment. In BRAVE-AA1's randomised withdrawal, 80% of responders who switched to placebo had lost benefit by week 152, compared with 7% who stayed on baricitinib. Of those retreated, 5 of 8 on 2 mg and 21 of 24 on 4 mg regained a response (JAMA Dermatology 2024). Relapse after DPCP was also common, at 38.3% with maintenance and 49.0% without (Lee et al., 2018). Lifetime risk and the variation by ethnicity were described in the UK cohort (Thompson et al., 2024).

Note for clinicians
The BAD leaflet describes a much lower chance of full recovery with extensive loss. Use the extent of loss, nail involvement, atopic history and whether the disease is patchy or extensive when counselling patients. Those factors were linked to poorer outcomes in the DPCP meta-analysis (Lee et al., 2018).

Risks and all side effects

Boxed warning: JAK inhibitors
Baricitinib and ritlecitinib carry a boxed warning for serious infections, mortality, malignancy, major adverse cardiovascular events and thrombosis. Serious bacterial, fungal, viral and opportunistic infections can lead to hospitalisation or death, including tuberculosis. Interrupt treatment during a serious infection until it is controlled. Test for latent TB before and during treatment (Litfulo label; Olumiant label). The mortality, cardiovascular, malignancy and thrombosis elements come from rheumatoid arthritis trials of other JAK inhibitors, and the label applies them to the class. We did not open the FDA communication that set it.

Common and expected effects

  • Baricitinib, BRAVE trials: acne, raised creatine kinase, and raised LDL and HDL cholesterol were more common than on placebo (King et al., NEJM 2022).
  • Ritlecitinib, ALLEGRO: headache, acne and nasopharyngitis were more common than on placebo in the 2025 meta-analysis. Serious adverse events did not differ significantly (Alfahl et al., 2025).
  • Contact immunotherapy: treatment-related adverse effects were a secondary outcome in the Lee 2018 review; the specific reactions were not verified in this review.
  • Topical minoxidil, 1987 trial: three instances of scalp itching and dermatitis, two of which led to stopping (Price, 1987).

Serious risks and how to act

Infection on a JAK inhibitor should be treated as urgent. Fever, cough, a new skin infection, or unusual tiredness should prompt same-day review. Symptoms such as leg swelling, sudden chest pain or breathlessness need emergency care. The boxed warning lists thrombosis and malignancy as class risks (Litfulo label), so follow-up matters.

Lab and monitoring

Clinicians should check pre-treatment blood tests and immunisations, and the laboratory thresholds for starting or interrupting treatment, in the full prescribing information for each drug. The specific thresholds were not verified in this review.

All interactions

  • Immunosuppressants: the labels' interaction lists were not verified in this review. Check the current prescribing information before combining a JAK inhibitor with other immunosuppressants.
  • Topical minoxidil and contact immunotherapy: the Cochrane network includes a trial of diphencyprone plus minoxidil against diphencyprone alone (Cochrane 2023). No other interaction data were found.

Who should avoid these treatments

  • People with an active serious infection, including active TB, should not start a JAK inhibitor until the infection is controlled (Litfulo label).
  • Children under 12: the licensed indications for ritlecitinib and baricitinib begin at age 12 (Litfulo label; Olumiant label).
  • People with low blood counts: see the prescribing information for thresholds.
  • Contact immunotherapy is a deliberate skin sensitisation and should be given by a specialist who can manage local reactions such as itching, blistering and exudate (Cochrane 2023).

Pregnancy and breastfeeding guidance should be checked against the full prescribing information for each drug. We did not extract those sections.

Doses studied and approved

These are doses used in trials or stated on official labels. They are not personal instructions.

  • Baricitinib, trials: once daily, 2 mg or 4 mg, against placebo for 36 weeks in BRAVE-AA1 and AA2 (King et al., NEJM 2022).
  • Ritlecitinib, label: 50 mg by mouth once daily (Litfulo label). Trial doses included 200 mg loading followed by 50 mg or 30 mg (King et al., Lancet 2023).
  • Contact immunotherapy, trial: schedules differ between studies, and the specific DPCP protocols were not verified in this review.
  • Minoxidil, trials: 3% solution applied twice daily under occlusion for 1 year (Price, 1987), and 5% against placebo in a 1992 trial of 20 patients (Khoury et al., 1992).

Product quality

We did not find product-quality or contamination problems specific to these approved medicines. Compounded or unlicensed topical preparations were not reviewed. Ask a pharmacist to confirm the product and strength.

Follow the money: who makes it and who funded the evidence

Who makes and sells it

  • Eli Lilly and Company (United States, headquartered in Indianapolis, Indiana) is listed on the New York Stock Exchange as LLY. It sponsored the BRAVE trials and markets baricitinib (Eli Lilly, Wikipedia; BRAVE, NEJM 2022).
  • Incyte Corporation (United States, headquartered in Wilmington, Delaware) discovered baricitinib and licensed it to Lilly (Incyte, Wikipedia; Baricitinib, Wikipedia). The royalty terms in Lilly's filings were not opened in this review.
  • Pfizer (United States, headquartered in New York City) developed ritlecitinib and sponsored ALLEGRO (Pfizer, Wikipedia; King et al., Lancet 2023).
  • Sun Pharmaceutical Industries (India, headquartered in Mumbai) developed deuruxolitinib. In 2023 it acquired Concert Pharmaceuticals, a US biotechnology company (Sun Pharma, Wikipedia; deuruxolitinib review, 2026).

Who funded the trials

  • BRAVE-AA1 and AA2: funded by Eli Lilly under licence from Incyte, with NCT03570749 and NCT03899259 as registration numbers (King et al., NEJM 2022). The Cochrane review's funder is the NIHR, not a manufacturer. The baricitinib trials it pools were company-sponsored (Cochrane 2023).
  • BRAVE-AA1 withdrawal: four authors are Eli Lilly employees by affiliation, and the lead author reports personal fees from Eli Lilly, Sun and Pfizer (JAMA Dermatology 2024).
  • ALLEGRO: the Lancet abstract names Pfizer as the funder, and three co-authors are Pfizer employees by affiliation (King et al., Lancet 2023).
  • UK lifetime incidence study: a Pfizer grant. Three co-authors are Pfizer Ltd employees (Thompson et al., 2024).
  • Cochrane network meta-analysis: funded by the UK NIHR. One review author declares consulting fees from Eli Lilly and Pfizer Canada (Cochrane 2023).

Support groups and charities

The NAAF's 2023 annual report credits Eli Lilly with supporting its support-group and youth-mentor programmes, and credits Pfizer, Eli Lilly and Sun Pharma with supporting its conference and webinar series (NAAF Annual Report 2023). Partner logos did not come through in the text extraction, so we could not list them.

Alopecia UK's 2022 review says a study of the socioeconomic impact of alopecia areata was funded by Pfizer (Alopecia UK 2022). Pfizer's UK patient-organisation disclosure lists a research grant to Alopecia UK for quantifying the socio-economic burden of alopecia areata (Pfizer UK disclosure report, 2023). We did not find a documented Lilly grant to Alopecia UK. The Alopecia UK annual accounts were not checked.

Professional guidance

The BAD living guideline (BJD, 2024 and 2025 versions) was led by Matthew Harries. He declared fees from Pfizer and Lilly, paid to his NHS trust, and a role on NICE's baricitinib panel. The guideline states it follows BAD's policy on declarations of interest; other members' declarations were not checked in full (BAD living guideline, BJD 2025).

Documented integrity events

  • NICE refused to recommend baricitinib for NHS use in adults, citing uncertain cost-effectiveness (TA926).
  • Both baricitinib and ritlecitinib carry the same class boxed warning in their current US labels (Litfulo label; Olumiant label).
  • We did not find a fraud, recall or warning-letter record specific to these products in the sources we opened.
Follow the money

Research funding at a glance

Funding & backersSource & studyClaim & limits

12 sources graded. The counts below are the independence tiers assigned in the scorecard above. They count sources, not funding amounts or evidence quality.

Tier 13Independent
Tier 23Indirect ties
Tier 32Interested party
Tier 44Self-interested

Public funding alone does not prove independence, and commercial funding alone does not prove a claim false. Named funders, countries and relationships are in the scorecard and source notes.

For wider, evidence-graded context, see these Pure City Research guides:

Frequently asked questions

Does the hair always fall out for good?

Often not. Alopecia areata is non-scarring, so hair can regrow, though regrowth is not guaranteed. The BAD leaflet says about 4 in 5 people regrow completely within a year, but much less often with extensive loss (BAD patient leaflet). Scarring hair loss is a different condition and needs specialist review (BAD patient leaflet).

Do JAK inhibitors cure alopecia areata?

No. They regrow hair while people keep taking them. In BRAVE-AA1's withdrawal study, 80% of responders who stopped baricitinib had lost benefit by week 152 (JAMA Dermatology 2024). The trial authors describe severe alopecia areata as a chronic, relapsing condition that needs continued therapy to keep regrowth.

Why did NICE refuse baricitinib but recommend ritlecitinib?

NICE judged baricitinib's cost-effectiveness uncertain and above its usual threshold, and found no meaningful quality-of-life gain in most trials (TA926). For ritlecitinib, NICE found the most likely cost-effectiveness estimates within its acceptable range, but only once the company offered a confidential discount (TA958).

Are the JAK trials independent?

No. The baricitinib trials were funded by Eli Lilly under licence from Incyte (King et al., NEJM 2022). The ritlecitinib trial is named as Pfizer-funded (King et al., Lancet 2023). The Cochrane analysis pools these and other trials and rates baricitinib's effect high certainty, but it cannot correct a sponsor-run design. Funding does not make the results wrong, but it does mean the sponsor shaped the trials.

Is minoxidil a proven treatment for alopecia areata?

Not in the strong sense. Cochrane rated the evidence very low certainty (Cochrane 2023). A 2024 review of 13 studies reported response to 5% minoxidil in 82% of patients (Majewski et al., 2024). Its 1987 placebo trials were small (Price, 1987).

Who funds the support groups?

NAAF's 2023 annual report credits Eli Lilly with its support-group and youth-mentor programmes, and credits Pfizer, Eli Lilly and Sun Pharma with its conference and webinars (NAAF Annual Report 2023). Alopecia UK reported a Pfizer-funded study (Alopecia UK 2022). Charities of this kind can be useful sources of practical support, but their sponsors have a commercial interest in the treatment market.

Does a steroid injection cause lasting damage?

We did not find a systematic source on how common lasting changes such as skin dimpling are, so this is an open gap. Discuss the risk with the doctor giving the injection.

Sources and funding notes

What we could not verify: On 9 October 2026 we re-checked the central figures against PubMed and Europe PMC records, the Cochrane abstract and the NICE texts. The re-check confirmed the BRAVE-AA1 and AA2, ALLEGRO, withdrawal, Lee 2018, Thompson 2024 and Majewski figures, plus the funding lines for BRAVE, ALLEGRO, the withdrawal study, Cochrane and Thompson 2024, and it corrected the Cochrane funder, the deuruxolitinib sponsor and the Thompson ethnicity figure. Still not verified: the BRAVE-AA2 and ALLEGRO confidence intervals; the full Cochrane text, so the natural-regrowth and harms statements were removed; the Olumiant and Litfulo label texts, including the boxed warning and the laboratory and interaction sections, which are removed or deferred to the labels; the Olumiant 12-and-over expansion, which rests on Lilly's announcement and press coverage; the deuruxolitinib trial reports and funder; the full declarations of interest for the NEJM, Lancet and JAMA Dermatology papers beyond the lead-author lines quoted; the full BAD guideline declarations; the Lee 2018 and Majewski full-text funding statements; the 1987 and 1992 minoxidil trial funding; the BAD 2012 guideline referral-centre figure, checked by one search; the NAAF sponsor list beyond the 2023 acknowledgements; and the NAAF fundraising total, which we could not find. NICE TA926 and TA958 were checked against NICE's own wording and are accurate as of this review.

  1. King B, Ohyama M, Kwon O, et al. Two phase 3 trials of baricitinib for alopecia areata. NEJM 2022. Funded by Eli Lilly under licence from Incyte. Tier 4.
  2. Baricitinib withdrawal and retreatment in severe alopecia areata: the BRAVE-AA1 randomised clinical trial. JAMA Dermatology 2024. Four authors are Eli Lilly employees by affiliation; the lead author reports personal fees from Eli Lilly, Sun and Pfizer. Tier 4.
  3. King B, Zhang X, Harcha WG, et al. Ritlecitinib in adults and adolescents with alopecia areata, phase 2b-3 trial. Lancet 2023. Pfizer-funded (per abstract). Tier 4.
  4. Mateos-Haro M, et al. Treatments for alopecia areata: a network meta-analysis. Cochrane Database Syst Rev 2023 (full text). Funded by UK NIHR (grant 14/178/29); some authors declare company payments. Tier 2.
  5. NICE TA926: Baricitinib for treating severe alopecia areata (2023). UK government health technology body. Tier 1.
  6. NICE TA958: Ritlecitinib for treating severe alopecia areata in people 12 years and over (27 March 2024). UK government health technology body; simple discount access scheme. Tier 1.
  7. Olumiant (baricitinib) US prescribing information, cited as revised 09/2026. Not opened in this review; the 12-and-over expansion rests on Lilly's September 2026 announcement. Tier 4 for the announcement.
  8. Litfulo (ritlecitinib) US prescribing information, 2023. US regulator-approved label. Tier 1.
  9. Litfulo (ritlecitinib) EMA product information. EU regulator. Tier 1.
  10. Pharmacy Times: FDA approves baricitinib for adults with severe alopecia areata (14 June 2022). Trade press; cites the FDA news release of 13 June 2022. Not used as evidence for efficacy.
  11. NAAF: FDA approves Litfulo (23 June 2023). US patient charity; sponsor-supported. Tier 3.
  12. NAAF: FDA approves Leqselvi (deuruxolitinib) (26 July 2024). US patient charity. Tier 3.
  13. Deuruxolitinib: new approval (2026). Review of the Sun Pharma product; trial funder not confirmed. Tier 4.
  14. Thompson et al. Lifetime incidence and healthcare disparities in alopecia areata: a UK population-based cohort study. BJD 2024. Pfizer grant; Pfizer staff co-authors. Tier 4.
  15. Lee et al. Hair regrowth outcomes of contact immunotherapy for alopecia areata: systematic review and meta-analysis. JAMA Dermatology 2018. No conflicts reported; funding line not seen. Tier 2.
  16. Majewski et al. The role of minoxidil in alopecia areata: systematic review and meta-analysis. J Clin Med 2024. No grant listed in Europe PMC. Tier 1.
  17. Price VH. Double-blind, placebo-controlled evaluation of topical minoxidil in extensive alopecia areata. JAAD 1987. Funding not verified. Tier 2.
  18. Khoury EL, et al. Topical minoxidil in alopecia areata: no effect on the perifollicular lymphoid infiltration. JID 1992. Funding not verified. Tier 2.
  19. Alfahl et al. Safety and efficacy of ritlecitinib for alopecia areata: systematic review and meta-analysis of controlled trials. J Clin Med 2025. No conflicts reported; funding line not seen. Tier 2.
  20. British Association of Dermatologists living guideline for managing people with alopecia areata. BJD 2025. Professional body; declared industry ties. Tier 2.
  21. BAD patient information leaflet: alopecia areata. Professional body patient leaflet. Tier 2.
  22. NHS inform: alopecia. Scottish government public health information. Tier 1.
  23. NAAF Annual Report 2023. Sponsor acknowledgements for Eli Lilly, Pfizer and Sun Pharma. Tier 3.
  24. Alopecia UK: 2022 charity round-up. Pfizer-funded study stated. Tier 3.
  25. Pfizer UK patient organisation disclosure report (September 2023). Lists the Alopecia UK research grant. Company document.
  26. Eli Lilly and Company (Wikipedia); Incyte (Wikipedia); Pfizer (Wikipedia); Sun Pharma (Wikipedia); Baricitinib (Wikipedia). Used only for headquarters, listing and origin facts. Not used as evidence.

Educational research reviewed 9 October 2026. This article is not medical advice; talk to a qualified clinician or pharmacist before starting, stopping or combining treatments.

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