Do you switch to a different JAK inhibitor rather than escalating dose or adding adjunctive therapy in patients with severe alopecia areata who have had a partial but suboptimal response after 24 weeks of treatment?

If they are having zero response, then I might switch. But if there is any response at all, I would wait a full year before switching. If not on already, consider adding oral minoxidil, topical steroids, or intrapersonal steroids.

I agree with @Dr. First Last- if someone is showing at least some hair regrowth at 24 weeks of treatment, then I'm likely to give more time for treatment, particularly in patients who are very severe (alopecia totalis/universalis or close). I typically start. patients on oral minoxidil at the same time as JAK inhibitors, but I might consider increasing the dose as well. If someone has had a partial response and then plateaued entirely for 3-6 months, then it might be a time when we discuss a trial of a different JAK inhibitor.