Janus Kinase Inhibitors for the Treatment of Severe Alopecia Areata: An Open-Label Comparative Study

Abstract

Background: Alopecia areata (AA) is a common autoimmune disorder characterized by patchy hair loss. There are many treatments available for AA. However, treatments of severe forms of AA are not satisfactory. Recently, oral Janus kinase (JAK) inhibitors were found to be effective for the treatment of severe AA variants. Objective: The aim of this work was to evaluate and compare the efficacy, side effects, and durability of two oral JAK inhibitor medications (ruxolitinib and tofacitinib) in the treatment of severe AA. Methods: This study included 75 patients with AA with more than 30% scalp hair loss, alopecia totalis, and alopecia universalis randomized into 2 groups. The first group (n = 38) received ruxolitinib 20 mg twice daily, and the second group (n = 37) received oral tofacitinib 5 mg twice daily. The treatment continued for 6 months followed by 3 months of follow-up off therapy. Efficacy of treatment was assessed by monitoring the change in the Severity of Alopecia Tool (SALT) score. Results: Both tofacitinib and ruxolitinib induced remarkable hair regrowth, with a mean change in SALT score of 93.8 ± 3.25 in the ruxolitinib group and 95.2 ± 2.69 in the tofacitinib group. However, the ruxolitinib group showed a shorter duration for initial hair regrowth. There was no statistically significant difference between the groups regarding hair regrowth at the end of the 6-month treatment and relapse rate at the end of the 3-month follow-up. Around two thirds of cases experienced relapse. Both drugs were well tolerated, with no reported serious adverse effects. Conclusion: Both ruxolitinib and tofacitinib could be considered effective and well-tolerated treatments for extensive AA.

Janus kinase inhibitors: An innovative treatment for alopecia areata

“…), the effectiveness of ruxolitinib is expected to be slightly greater than or comparable with that of tofacitinib. In fact, the treatment outcomes, side‐effects and recurrence rates of these two drugs were not statistically significantly different in a comparative trial with a small number of patients . Although reports on baricitinib are scarce, baricitinib is theoretically expected to be as effective as ruxolitinib.…”

“…Among the reports addressing the treatment of AA with oral JAK inhibitors, Table 1 summarizes the results of studies that included more than 10 patients and focused on scalp hair growth. [4][5][6][7][8][9][10][11][12][13] In clinical trials using systemic agents for extensive AA, an improvement of 50% in the Severity Alopecia Tool (SALT) score relative to the baseline SALT score is generally considered an acceptable end-point. Thus, oral JAK inhibitors can be considered attractive candidates to treat moderate to severe AA.…”

“…Among the previous studies listed in Table 1, most were on tofacitinib, and only two articles contained data on ruxolitinib. 5,6 Considering the mechanism of AA ( Fig. 1), the effectiveness of ruxolitinib is expected to be slightly greater than or comparable with that of tofacitinib.…”

“…In fact, the treatment outcomes, side-effects and recurrence rates of these two drugs were not statistically significantly different in a comparative trial with a small number of patients. 6 Although reports on baricitinib are scarce, baricitinib is theoretically expected to be as effective as ruxolitinib. However, little is currently known about the relative efficacy or safety of inhibiting JAK1, 2 or 3 for AA treatment.…”

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

“…Recent researches showed that cytotoxic T lymphocytes are central to AA pathogenesis, and hereby these lymphocytes can be targeted by systemic Janus kinase (JAK) inhibitors such as tofacitinib (TOFA). Despite promising results with TOFA in the treatment of AA, there is still search for new therapies in AA (Almutairi, Nour, & Hussain, 2019;Castelo-Soccio, 2017;Liu, Craiglow, Dai, & King, 2017).…”