Tofacitinib Shows Promise as Treatment for Alopecia Areata
Alopecia areata (AA) is a common autoimmune disorder, but there are no reliably effective therapies. Some research has shown that Janus kinase (JAK) inhibitors may be a promising novel therapy for treating this recalcitrant disease.
A recent study examined the effectiveness and safety of using tofacitinib, a JAK inhibitor, as a treatment for severe AA, alopecia totalis (AT), defined as loss of all scalp hair, and alopecia universalis (AU), defined as loss of all body hair. Ninety patients met all of the inclusion criteria for the study, 40 men and 50 women, with a median age at time of treatment of 34.5 years. Efficacy of the treatment was evaluated using before and after photographs and by the Severity of Alopecia Tool (SALT) score, a validated tool that measures percentage of scalp hair loss. Clinical response to tofacitinib was defined as greater than 5% change in SALT score and a complete clinical response was defined as greater than 90% change in SALT score.
Most patients received tofacitinib 5 mg twice daily for the first 2 to 3 months of treatment. Depending on the amount of regrowth at 2 to 3 months, patients either continued therapy or adjuvant therapy was begun. Adjuvant therapy included either tofacitinib 5 mg twice daily plus prednisone or higher-dose tofacitinib up to 10 mg twice daily with or without prednisone. Clinical response was achieved by 77% of patients, with 58% of patients achieving intermediate or complete response over 4 to 18 months of treatment. There were no serious adverse events reported over the treatment period. Though previous studies had not shown a significant benefit of pulsed prednisone on AT or AU, its use as adjuvant therapy in this study was associated with sustained hair regrowth in patients who were not demonstrating significant regrowth with tofacitinib monotherapy.
The authors conclude that long-term use of tofacitinib was effective and well tolerated for the treatment of severe AA, AT, and AU. The authors note that the results of this study will help to guide clinical trials, which will be important for detailing the efficacy and safety of JAK inhibitors in this disease.
Byline: Martha L. Sikes, MS, RPh, PA-C
Posted: February 13, 2017
Adapted from the original article.