A medication commonly prescribed for rheumatoid arthritis — upadacitinib (brand name Rinvoq) — produced substantial hair regrowth in people with severe alopecia areata in two large phase 3 clinical trials, researchers report.
The trials, published August 12 in JAMA Dermatology, enrolled nearly 1,400 participants aged 12 to 64 who all had lost at least half of the hair on their scalps. The studies were conducted at more than 200 clinical sites across dozens of countries between November 2023 and July 2025. Participants were randomly assigned to one of three groups: 15 mg daily of upadacitinib, 30 mg daily, or placebo. Hair growth was measured at weeks 4, 8, 12 and 24, followed by a 28-week blinded extension to assess longer-term outcomes.
Key findings
– Nearly half of those taking 15 mg daily regained enough hair to cover at least 80% of their scalp within 24 weeks. The 30 mg dose produced even stronger results, with more than 54% of participants reaching the same 80% coverage threshold. About 2% of people given placebo achieved comparable results.
– More than 35% of the 15 mg group and roughly 46% of the 30 mg group achieved 90% or greater scalp coverage, versus about 1% of placebo participants.
– Complete scalp regrowth was seen in about 13% of the lower-dose group and 23% of the higher-dose group; almost none of the placebo group experienced full regrowth.
– The higher dose also produced notable eyebrow and eyelash regrowth in over half of those treated.
How it works
Upadacitinib is a Janus kinase (JAK) inhibitor, a class of drugs that blocks proteins involved in inflammatory and immune responses. Alopecia areata is an autoimmune condition in which the immune system attacks hair follicles, so JAK inhibitors can reduce that immune-driven inflammation and allow hair to regrow. Several other JAK inhibitors are already FDA-approved for severe alopecia areata, and upadacitinib may become an additional option.
Safety and side effects
The most commonly reported side effects in the trials were acne, upper respiratory infections (colds), sore throat, and throat irritation. Serious adverse events were uncommon. Because JAK inhibitors act systemically on the immune system, clinicians emphasize the importance of proper screening, monitoring, and follow-up to manage potential risks.
Clinical and practical considerations
Dermatology experts not involved in the studies described the results as encouraging. Because upadacitinib is already approved for other conditions, its safety profile is better characterized than a brand-new drug, which may help physicians and patients weigh the benefits and risks. Still, treatment decisions are highly individual: some people with severe alopecia who accept the risks may prefer systemic therapy to restore hair, while others may choose different approaches.
Patients should also be aware that stopping JAK inhibitor treatment can allow alopecia to return; for some people, maintaining regrowth may require long-term therapy and regular medical oversight.
Context on hair loss
Hair loss affects millions of people. In the U.S. roughly 80 million people experience hair loss at some point, and about 7 million have alopecia areata. Causes include hereditary pattern hair loss (androgenetic alopecia) and autoimmune forms such as alopecia areata. Treatments range from topical drugs and injections to systemic medications, light therapies, and hair transplant surgery, depending on the diagnosis and severity.
Practical hair-care tips
To protect existing hair and reduce additional damage, experts recommend limiting high-heat styling (blow dryers, straighteners), avoiding overly tight hairstyles, minimizing chemical processing (bleaching, frequent coloring), gently drying hair rather than vigorous rubbing, and maintaining a balanced, nutrient-rich diet.
Emotional impact
Beyond the physical changes, hair loss can cause significant emotional distress, including anxiety, depression, and social withdrawal. Patients and clinicians should discuss both the psychological effects of alopecia and the potential benefits and risks of treatments when making care decisions.
Bottom line
The phase 3 trials show that upadacitinib can produce meaningful hair regrowth for many people with severe alopecia areata, adding a potential new treatment option to the growing class of JAK inhibitors. As with other systemic immune-modulating therapies, careful patient selection, monitoring, and discussion of long-term risks and benefits are essential.
