305 - Perceived Efficacy and Risks of Janus Kinase Inhibitors in Pediatric Alopecia Areata: A Cross-Sectional Survey

Publication Number: 2295.305

Adrienne Conza, University of Massachusetts Medical School, Worcester, MA, United States; Sarah Lee, Harvard Medical School, Boston, MA, United States; Itohan Aigbekaen, Boston Children's Hospital, Mableton, GA, United States; Jasmine Chang, Boston Children's Hospital, Brookline, MA, United States; Yasin Damji, Boston Children's Hospital, Boston, MA, United States

Background: Oral Janus kinase inhibitors (JAKi) are increasingly prescribed for alopecia areata (AA) in pediatric populations. Despite expanding use, little is known about how young patients and their caregivers perceive treatment benefits when also considering possible risks, including boxed warnings for malignancy, serious infection, and major adverse cardiovascular events.

Objective: To assess satisfaction, perceived benefit, and benefit-risk judgements related to JAKi therapy for AA.

Design/Methods: We surveyed 41 patients under age 25 with physician-diagnosed AA who were receiving oral JAKi. The survey assessed satisfaction, benefit-risk/continuation decisions under explicit risk framings, and included a free-text item.

Results: Of 41 eligible patients, 24 completed the survey (59% response). Participants had a median age of 15 years (range 9–25); 60% identified as female, 36% as male, and 4% as non-binary. Median treatment duration was 11 months. Perceived disease severity improved markedly from a median of 7/10 (range: 1-10) at disease onset to 2/10 (range: 0-10) at the time of survey. Overall satisfaction was high with 65% strongly satisfied and 21% satisfied; dissatisfaction was uncommon (13%, n=3) and attributed to lack of efficacy or slow onset of response. When asked to consider hypothetical risks, most respondents judged treatment “worth it and will continue” in both growth impairment (83%) and serious-risk (malignancy, thrombosis, and cardiac events) scenarios (88%).

Conclusion(s): These findings suggest that youth and caregivers perceive substantial benefit from JAKi therapy for AA and are generally willing to continue treatment despite potential risks. Such perspectives are essential to guide counseling, shared decision-making, and ongoing evaluation of long-term safety.