How do you choose between various JAK inhibitors in the management of alopecia areata?

Mostly, the first line is baricitinib as it has been approved the longest. However, if a patient has lipid abnormalities at baseline, you could consider ritlecitinib, which does not impact the lipid profile. At the same time, however, ritlecitinib interacts with statins and other CYP3A and 1A2 medications (it inhibits these enzymes), so it may be less ideal in patients on any of those medications. Deuruxolitinib, as a newer option, is more similar to baricitinib and is twice daily dosing. Given less experience with it, we tend to use it less, but likely will be using it more with time.

Strictly speaking, there are no head-to-head trials, so no clear advantage of one over the other. Of course, ritlecitinib has the approval for ages 12 and up...