Experience with oral tofacitinib in severe alopecia areata with different clinical responses

Abstract

Background Alopecia areata (AA) and generalized form, universalis (AU) are common causes of noncicatricial alopecia, targeting anagen hair follicles. A dominant interferon‐gamma transcriptional signaling and cytotoxic T lymphocytes were accused as the main drivers of disease pathogenesis. Tofacitinib is a Janus kinase inhibitor that has been proven to interfere with the positive feedback loop between the follicular cell and the cytotoxic T lymphocytes in AA. There is an increasing number of studies reporting success with tofacitinib in AA. Aims We aimed to assess oral tofacitinib's safety and efficacy in 13 recalcitrant AA and AU patients. Methods This is a retrospective pilot study performed between 2017 and 2020. The demographic features and the treatment responses were evaluated with Severity of Alopecia Tool score changes. Results Thirteen recalcitrant alopecia areata patients (3 AA, 10 AU), aged between 17 and 49, were included in the study. The treatment duration was 3‐15 months. All three AA patients responded well; however, the therapy was unsuccessful in five of ten AU patients. Relapse was observed in one of the AA and three of the AU responders. Acneiform lesions and elevation of transaminases were the major side effects. Conclusion Tofacitinib seems to be more promising and thriving in the treatment of AA than AU. Starting the therapy earlier can bring more successful results. Unfortunately, even in the cases that fully respond to treatment, relapse can be observed after discontinuation of the treatment. It is essential to inform patients about this situation in reducing the frustrations that may occur later.

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

“…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 caseseries (18, 23, 24, 29-32, 34-38, 40, 41, 45-50, 52). Four studies included only children with AA (24,35,36,46), 5 studies both children and adults (28,32,37,45,47), and the rest included only adults ( Twenty-four studies investigated oral tofacitinib, where the most common dose of the drug was 5 mg twice daily (18, 23, 24, 28-30, 32-36, 38-43, 45, 47, 49-53).…”

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

“…Since the first report in 2014, 9 tofacitinib has been investigated for its potential benefits in AA: there is a growing body of evidence on AA managed with oral and topical tofacitinib. Unfortunately, real‐world experience of JAK inhibitors in AA relies on case reports, small case series 10,11 and retrospective studies, 12–15 but real‐life prospective data on efficacy are still lacking.…”

Ritlecitinib and brepocitinib demonstrate significant improvement in scalp alopecia areata biomarkers

“…Clinical response has been shown to be influenced by disease duration. 11,48 Therefore, combining both active treatment arms together, we evaluated whether duration of the active hair loss episode correlated with percentage improvement from baseline in SALT score. As shown in Fig 4, A, longer duration of the active hair loss episode was significantly inversely correlated with the percentage improvement in SALT score at both week 12 (r 5 20.47) and week 24 (r 5 20.4) (P < .05 for both).…”