Experience with oral tofacitinib in two adolescents and seven adults with alopecia areata

Abstract

Alopecia areata (AA) is a common disease that results in nonscarring hair loss. Recently, tofacitinib (TOFA) has been a novel promising therapy for AA. The aim of this study is to determine the efficacy of oral TOFA treatment for alopecia areata (AA), and alopecia universalis (AU). Data of nine patients treated with oral TOFA with either AA or AU were retrospectively evaluated. Treatment outcome, disease severity, and therapeutic response were evaluated by Severity of Alopecia Tool (SALT) scores along with regular photographic surveillance done at third and sixth months. Treatment response was established on four categories: complete response (90% change in latest SALT score), intermediate response (51–90% change), moderate response (6–50% change), and nonresponse (<5% change). Nine patients aged 13–33 years were reviewed. Four patients (44.4%) did not respond to oral TOFA therapy, three patients (33.3%) were moderate responders, 1 (11.1%) was intermediate responder, and 1 (11.1%) was complete responder at the end of 6 months. The clinical response rate (those who achieved ≥5–100% change in SALT score) was 41.4% for all patients. Most of the patients who responded to TOFA had AA instead of AU. Adverse effects were mild. The clinical response rate of TOFA seems reasonable and TOFA was well‐tolerated in this cohort. However, to truly evaluate efficacy, future studies are needed to assess the efficacy, adverse effects, and durability of treatment with TOFA in randomized controlled trials.

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

“…Acceptable treatment success is generally defined as an improvement over 50% in the SALT scores, 9 reported between 32% and 66% in the literature 6 . In our study, although 61.5% of the patients using tofacitinib had varying degrees of hair growth, only 53.8% were found to be good responders (76%‐100% SALT score change), which is compatible with the literature 15‐18 …”

“…The median disease duration in our study was 10 years (3‐26 years). While the treatment's success is similar to the literature, 15‐19 five of the eight patients (63.5%) who responded to varying degrees had recurrence no later than 12 months (median four months) after the treatment. We also think that the selection of resistant cases was a reason for the high recurrence rate.…”

“…We also think that the selection of resistant cases was a reason for the high recurrence rate. Although Phan et al opposed this opinion in their meta‐analysis, 15 our study results supported the view that prolonged disease duration, high initial SALT scores, and AT/AU subtypes may be responsible for the high recurrence rate 5,16 …”

“…In the study of Serdaroglu et al, 5% of patients showed resistance to treatment 19 . In another report, four of 9 patients did not respond tofacitinib 16 . In our study, resistance rate was found as 38.5%.…”

A Comprehensive Literature Review of JAK Inhibitors in Treatment of Alopecia Areata

“… Patients followed for 6 months after drug cessation; 1 patient had no hair loss within 4 months; 2 patients had a relapse within 2 and 4 months. Acneiform eruptions (2) (Akdogan et al, 2019) 55 Retrospective study 9 patients; 4 males and 5 females; 13–33 years -AA -AU Oral tofacitinib (5mg BD x 6 months) Of the 9 patients, 5 patients responded to therapy: 3 patients were moderate responders (6–50% reduction in SALT), 1 patient was intermediate (51–90% reduction in SALT) and 1 patient was a complete responder (>90% reduction in SALT). 4 patients did not respond.…”