Effectiveness of Oral Tofacitinib Dose Tapering in a Case of Alopecia Areata Universalis

Esteves, Mariana; Lopes, Sofia; Azevedo, Filomena; Pedrosa, Ana Catarina

doi:10.1159/000510673

Cited by 5 publications

(8 citation statements)

References 15 publications

(61 reference statements)

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“…A total of 37 studies matched the inclusion criteria and were included in this study ( 18 – 54 ). Twenty-two studies originated from North America ( 18 – 22 , 26 , 27 , 29 , 31 , 35 , 37 , 41 , 42 , 44 – 48 , 50 , 51 , 53 , 54 ), 11 studies from Asia ( 28 , 32 – 34 , 36 , 38 – 40 , 43 , 49 , 52 ), 3 studies from Australia ( 24 , 25 , 30 ) and 1 study from Europe ( 23 ). The included original articles were 7 randomized trials ( 19 – 22 , 26 , 27 , 33 ), 5 non-randomized trials ( 25 , 42 , 44 , 53 , 54 ), 4 retrospective ( 28 , 39 , 43 , 51 ) and 21 case-series ( 18 , 23 , 24 , 29 – 32 , 34 – 38 , 40 , 41 , 45 – 50 , 52 ).…”

Section: Resultsmentioning

confidence: 99%

Comparative Efficacy and Safety of Janus Kinase Inhibitors Used in Alopecia Areata: A Systematic Review and Meta-analysis

et al. 2023

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The aim of this study was to compare the efficacy and safety of treatment with Janus kinase inhibitors for alopecia areata, measured by change in Severity of Alopecia Tool (SALT) score. A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was performed using Medline, EMBASE and Cochrane library. All studies investigating the efficacy of treatments for alopecia areata were included. Primary outcomes were the proportion of patients with alopecia areata achieving 30%, 50%, 75%, 90% and 100% improvement in SALT score after treatment with a Janus kinase inhibitor. A meta-analysis was performed including all randomized controlled trials investigating Janus kinase inhibitors. A total of 37 studies matched the inclusion criteria and were included. Meta-analysis was performed based on 5 randomized studies. Regarding patients with alopecia areata defined as ≥ 50% scalp hair loss, baricitinib 4 mg once daily demonstrated the highest efficacy. However, among patients with alopecia areata defined as a SALT score ≥ 50, oral deuruxolitinib 12 mg twice daily demonstrated the highest efficacy. Deuruxolitinib and baricitinib appear to be promising drugs for the treatment of alopecia areata. However, the response depends on the dosage of the drug. More randomized trials, with identical inclusion criteria and dose and duration of treatment, are required to confirm these findings.

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Section: Resultsmentioning

confidence: 99%

Comparative Efficacy and Safety of Janus Kinase Inhibitors Used in Alopecia Areata: A Systematic Review and Meta-analysis

et al. 2023

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“…In this study, as in the most studies, cases treated with a dosage of 5 mg twice a day of tofacitinib were followed after 6 month 18,28,29 . The average maintenance dose of the drug in our study was 7 mg daily, which reduced the risk of any side effects caused by increasing the dose of the drug.…”

Section: Discussionmentioning

confidence: 84%

“…In this study, as in the most studies, cases treated with a dosage of 5 mg twice a day of tofacitinib were followed after 6 month. 18,28,29 The average maintenance dose of the drug in our study was 7 mg daily, which reduced the risk of any side effects caused by increasing the dose of the drug. In studies conducted by Steves et al 29 and Ibrahim et al, 18 10 mg of tofacitinib was prescribed after 4-5 months follow-up for treatment stability.…”

Section: Discussionmentioning

confidence: 96%

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Effectiveness of oral tofacitinib treatment on patients with moderate‐to‐severe alopecia areata in Iran

Asilian,

Mohammadian,

Shahmoradi

2023

J of Cosmetic Dermatology

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IntroductionAlopecia areata is an inflammatory hair loss and a common autoimmune disease. Conducting treatment studies on alopecia areata is difficult due to unpredictable periods and even spontaneous recovery from the disease. In this study, the effectiveness of tofacitinib in treating alopecia areata was investigated.Materials and MethodsThe severity of the disease was evaluated using the Alopecia Severity Tool (SALT), and based on the medical history and patient's documents and photos, the score before and after the treatment was obtained. The patients were prescribed tofacitinib tablets at a dose of 5 mg twice a day for at least 6 months and were followed for a minimum of 18 months.ResultsNo side effect was observed in 97.9% of the patients. After 6 months, except for three patients who did not need any maintenance dose, others needed an average daily intake of 7 mg of tofacitinib. After 18 months, the hair loss decreased by 6.45 times compared to the beginning and by 0.5 times compared to the end of 6 months (p < 0.05). In addition, it was found that body hair loss decreased 4 times compared to the beginning and 0.6 times compared to the end of 6 months (p < 0.05). The reduction of nail involvement after 18 months and 6 months was 1.2 times and 0.6, respectively, (p < 0.05).ConclusionTreatment of alopecia areata with tofacitinib is recommended due to its effectiveness in reducing hair loss on the head, body, and nail involvement with few reversible side effects.

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“…21 This is one of the main shortcomings of these agents. Thus, maintenance therapy 13,22 or taper dose 23 after remission have been proposed. We adopted this approach as we found the maintenance therapy proved to be effective to prevent the recurrence of hair loss with minimal adverse events in our cohort.…”

Section: Resultsmentioning

confidence: 99%

Real‐world experience and long‐term evaluation of tofacitinib in refractory alopecia areata: A prospective, open‐label, single‐center study in Asian Arab population

Husein‐ElAhmed

Abdulla

Al-Obaidli

et al. 2022

Dermatologic Therapy

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Tofacitinib is a pan-janus kinase inhibitor (JAK) which has been tested off-label in alopecia areata (AA) with promising results. However, evidence of tofacitinib in real-life setting is still poor. We evaluated long-term efficacy and safety of tofacitinib for refractory AA. This is a prospective, open-label, observational, single-center cohort study conducted between January 2018 and December 2020. Primary end-point was the percent change in Severity of Alopecia Tool (SALT) at the basal visit and at the most recent follow-up visit. Three categories of treatment response were analyzed.Data on 47 participants of Arab-Asian heritage were analyzed. A complete and partial regrowth was observed in 18 patients (41.86%) and 11 patients (25.58%), respectively. In 12 patients (27.9%), no response was obtained. Most of the non-responders belonged to the alopecia universalis group (66.67%). No statistical differences were observed in rates of regrowth between pediatric and adult individuals (p = 0.52), nor between women and men. Significant differences in the average duration of tofacitinib treatment were obtained among the three categories of regrowth (p < 0.003), notably duration of AA did not impact the clinical regrowth (p = 0.62). To the best of our knowledge, this is the first prospective, observational, long-term study using tofacitinib in refractory AA. Rates of regrowth and side effects are analogous to previous works. Length of tofacinitib therapy should last for 12 months before considering any discontinuation or change, since early cessation can lead to treatment failures or incomplete regrowth. Maintenance therapy after complete regrowth has demonstrated to be safe and effective to prevent recurrences of hair loss.

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Effectiveness of Oral Tofacitinib Dose Tapering in a Case of Alopecia Areata Universalis

Cited by 5 publications

References 15 publications

Comparative Efficacy and Safety of Janus Kinase Inhibitors Used in Alopecia Areata: A Systematic Review and Meta-analysis

Comparative Efficacy and Safety of Janus Kinase Inhibitors Used in Alopecia Areata: A Systematic Review and Meta-analysis

Effectiveness of oral tofacitinib treatment on patients with moderate‐to‐severe alopecia areata in Iran

Real‐world experience and long‐term evaluation of tofacitinib in refractory alopecia areata: A prospective, open‐label, single‐center study in Asian Arab population

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