Advertisement

Tofacitinib for the treatment of severe alopecia areata and variants: A study of 90 patients

Published:November 02, 2016DOI:https://doi.org/10.1016/j.jaad.2016.09.007

      Background

      Alopecia areata (AA) is a common autoimmune disorder. There are no reliably effective therapies for AA.

      Objective

      We sought to evaluate the safety and efficacy of the Janus kinase 1/3 inhibitor, tofacitinib, in a series of patients over an extended period of time.

      Methods

      This is a retrospective study of patients age 18 years or older with AA with at least 40% scalp hair loss treated with tofacitinib. The primary end point was the percent change in Severity of Alopecia Tool (SALT) score during treatment.

      Results

      Ninety patients met inclusion criteria. Of 65 potential responders to therapy, defined as those with alopecia totalis or alopecia universalis with duration of current episode of disease of 10 years or less or alopecia areata, 77% achieved a clinical response, with 58% of patients achieving greater than 50% change in SALT score over 4 to 18 months of treatment. Patients with AA experienced a higher percent change in SALT score than did patients with alopecia totalis or alopecia universalis (81.9% vs 59.0%). Tofacitinib was well tolerated, and there were no serious adverse events.

      Limitations

      The retrospective nature of the data, the relatively small number of patients, and lack of a control group are limitations.

      Conclusion

      Tofacitinib should be considered for the treatment of severe AA, alopecia totalis, and alopecia universalis; tofacitinib dose response will be better defined by randomized controlled trials.

      Key words

      Abbreviations used:

      AA (alopecia areata), AT (alopecia totalis), AU (alopecia universalis), JAK (Janus kinase), SALT (Severity of Alopecia Tool)
      To read this article in full you will need to make a payment
      AAD Member Login
      AAD Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Safavi K.H.
        • Muller S.A.
        • Suman V.J.
        • et al.
        Incidence of alopecia areata in Olmsted County, Minnesota, 1975 through 1989.
        Mayo Clin Proc. 1995; 70: 628-633
        • Delamere F.M.
        • Sladden M.M.
        • Dobbins H.M.
        • et al.
        Interventions for alopecia areata.
        Cochrane Database Syst Rev. 2008; : CD004413
        • Xing L.
        • Dai Z.
        • Jabbari A.
        • et al.
        Alopecia areata is driven by cytotoxic T lymphocytes and is reversed by JAK inhibition.
        Nat Med. 2014; 20: 1043-1049
        • Craiglow B.G.
        • Tavares D.
        • King B.A.
        Topical ruxolitinib for the treatment of alopecia universalis.
        JAMA Dermatol. 2016; 152: 490-491
        • Craiglow B.G.
        • King B.A.
        Killing two birds with one stone: oral tofacitinib reverses alopecia universalis in a patient with plaque psoriasis.
        J Invest Dermatol. 2014; 134: 2988-2990
        • Jabbari A.
        • Dai Z.
        • Xing L.
        • et al.
        Reversal of alopecia areata following treatment with the JAK1/2 inhibitor baricitinib.
        EBioMedicine. 2015; 2: 351-355
        • Crispin M.
        • Ko J.
        • Craiglow B.G.
        • et al.
        Safety and efficacy of the JAK inhibitor tofacitinib citrate in patients with alopecia areata.
        JCI Insight. 2016; 1: e89776
        • Olsen E.
        • Hordinsky M.
        • McDonald-Hull S.
        • et al.
        Alopecia areata investigational assessment guidelines. National Alopecia Areata Foundation.
        J Am Acad Dermatol. 1999; 40: 242-246
        • Friedland R.
        • Tal R.
        • Lapidoth M.
        • et al.
        Pulse corticosteroid therapy for alopecia areata in children: a retrospective study.
        Dermatology. 2013; 227: 37-44
        • Smith A.
        • Trueb R.M.
        • Theiler M.
        • et al.
        High relapse rates despite early intervention with intravenous methylprednisolone pulse therapy for severe childhood alopecia areata.
        Pediatr Dermatol. 2015; 32: 481-487
        • Otberg N.
        • Finner A.M.
        • Shapiro J.
        Androgenetic alopecia.
        Endocrinol Metab Clin North Am. 2007; 36: 379-398
        • Wollenhaupt J.
        • Silverfield J.
        • Lee E.B.
        • et al.
        Safety and efficacy of tofacitinib, an oral Janus kinase inhibitor, for the treatment of rheumatoid arthritis in open-label, long-term extension studies.
        J Rheumatol. 2014; 41: 837-852
        • Fleischmann R.
        • Cutolo M.
        • Genovese M.C.
        • et al.
        Phase IIb dose-ranging study of the oral JAK inhibitor tofacitinib (CP-690,550) or adalimumab monotherapy versus placebo in patients with active rheumatoid arthritis with an inadequate response to disease-modifying antirheumatic drugs.
        Arthritis Rheum. 2012; 64: 617-629
        • Fleischmann R.
        • Kremer J.
        • Cush J.
        • et al.
        Placebo-controlled trial of tofacitinib monotherapy in rheumatoid arthritis.
        N Engl J Med. 2012; 367: 495-507
        • Liu L.Y.
        • King B.A.
        • Craiglow B.G.
        Health-related quality of life (HRQoL) among patients with alopecia areata: a systematic review.
        J Am Acad Dermatol. 2016; 75: 806-812
        • Colon E.A.
        • Popkin M.K.
        • Callies A.L.
        • et al.
        Lifetime prevalence of psychiatric disorders in patients with alopecia areata.
        Compr Psychiatry. 1991; 32: 245-251

      Linked Article