Therapeutic potential of oral tofacitinib in alopecia areata: a retrospective study

B. S. Chandrashekar; Varsha R. Koti; Madura Chandu; Chaithra Shenoy; Abhijna Chandar; M. S. Roopa; N. Lakshmi Narayana

doi:10.18203/issn.2455-4529.IntJResDermatol20243336

Authors

B. S. Chandrashekar Department of Dermatology, CUTIS Academy of Cutaneous Sciences, Bangalore, Karnataka, India
Varsha R. Koti Department of Dermatology, CUTIS Academy of Cutaneous Sciences, Bangalore, Karnataka, India
Madura Chandu Department of Dermatology, CUTIS Academy of Cutaneous Sciences, Bangalore, Karnataka, India
Chaithra Shenoy Department of Dermatology, CUTIS Academy of Cutaneous Sciences, Bangalore, Karnataka, India
Abhijna Chandar Department of Dermatology, CUTIS Academy of Cutaneous Sciences, Bangalore, Karnataka, India
M. S. Roopa Department of Clinical Research, CUTIS Academy of Cutaneous Sciences, Bangalore, Karnataka, India
N. Lakshmi Narayana Department of Clinical Research, CUTIS Academy of Cutaneous Sciences, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20243336

Keywords:

Alopecia areata, Oral tofacitinib, Janus kinase inhibitor, Multifocal alopecia areata, Alopecia totalis, Alopecia universalis, Alopecia sub-totalis

Abstract

Background: Alopecia areata (AA), a prevalent autoimmune disorder, poses challenges in management, particularly in severe cases. Recent advancements highlight janus kinase (JAK) inhibitors-tofacitinib demonstrating promise. However, the literature reports conflicting information on its safety profile, especially at higher doses, necessitating a comprehensive evaluation.

Methods: This retrospective analysis investigates the long-term efficacy and safety of oral tofacitinib in AA patients from January 2017 to October 2022. The study included 69 patients diagnosed with patchy multifocal AA (mfAA), alopecia totalis (AT), alopecia universalis (AU) or alopecia sub-totalis (AS). Data analysis incorporated demographic details, treatment history, autoimmune comorbidities, tofacitinib dosages, prior investigations, recurrence rates, and adverse effects. Efficacy was assessed using severity of alopecia tool (SALT) scores, with a grading system for percentage of hair regrowth.

Results: The study comprising of 58% males and 42% females, exhibited varied alopecia types. Treatment response analyzed through percent change in SALT score revealed 46.5% showed very good response to tofacitinib treatment, while 4.3% had excellent response (100% change in SALT score). 44.9% of patients showed no recurrence. Adverse effects were minimal, including acneiform eruptions and upper respiratory tract infections. Pearson correlations revealed age negatively correlated with hair regrowth percentage, suggesting older individuals exhibited lower regrowth responses.

Conclusions: Our findings endorse tofacitinib as a promising therapeutic option for the management of AA, with no serious side effects observed even during longer treatment durations. It can be regarded as the primary choice of treatment modality for moderate to severe forms of AA.

Metrics

Metrics Loading ...

References

Safavi KH, Muller SA, Suman VJ, Moshell AN, Melton LJ 3rd. Incidence of alopecia areata in Olmsted County, Minnesota, 1975 through 1989. Mayo Clin Proc. 1995;70:628-33.

Delamere FM, Sladden MM, Dobbins HM, Leonardi-Bee J. Interventions for alopecia areata. Cochrane Database Syst Rev. 2008;2:CD004413.

Oliveira AB, Alpalhão M, Filipe P, Maia-Silva J. The role of Janus kinase inhibitors in the treatment of alopecia areata: a systematic review. Dermatol Ther. 2019;32(5):e13053.

Guo L, Feng S, Sun B, Jiang X, Liu Y. Benefit and risk profile of Tofacitinib for the treatment of alopecia areata: a systemic review and meta-analysis. J Eur Acad Dermatol Venereol. 2020;34(1):192-201.

Shin JW, Huh CH, Kim MW, Lee JS, Kwon O, Cho S, et al. Comparison of the treatment outcome of oral tofacitinib with other conventional therapies in refractory alopecia totalis and universalis: a retrospective study. Acta Derm Venereol. 2019;99(1):41-6.

Xing L, Dai Z, Jabbari A, Cerise JE, Higgins CA, Gong W, et al. Alopecia areata is driven by cytotoxic T lymphocytes and is reversed by JAK inhibition. Nat Med. 2014;20:1043-9.

Phan K, Sebaratnam DF. JAK inhibitors for alopecia areata: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2019;33(5):850-6.

Akdogan N, Ersoy-Evans S, Doğan S, Atakan N. Experience with oral tofacitinib in two adolescents and seven adults with alopecia areata. Dermatol Ther. 2019;32(6):e13118.

Sharath S, Sardana K, Khurana A. A Real-World Study of Steroid-Free Monotherapy with Tofacitinib in Severe and Therapy-Recalcitrant Alopecia Areata, Alopecia Totalis, and Alopecia Universalis Cases: A Retrospective Analysis. Indian Dermatol Online J. 2023;15(1):49-54.

Jabbari A, Sansaricq F, Cerise J, Chen JC, Bitterman A, Ulerio G, et al. An Open-Label Pilot Study to Evaluate the Efficacy of Tofacitinib in Moderate to Severe Patch-Type Alopecia Areata, Totalis, and Universalis. J Invest Dermatol. 2018;138(7):1539-45.

Liu LY, Craiglow BG, Dai F, King BA. Tofacitinib for the treatment of severe alopecia areata and variants: A study of 90 patients. J Am Acad Dermatol. 2017;76(1):22-8.

Hogan S, Wang S, Ibrahim O, Piliang M, Bergfeld W. Long-term treatment with Tofacitinib in severe alopecia areata: an update. J Clin Aesthet Dermatol. 2019;12(6):12-4.

Kibbie J, Kines K, Norris D, Dunnick CA. Oral tofacitinib for the treatment of alopecia areata in pediatric patients. Pediatr Dermatol. 2022;39(1):31-4.

Park H, Yu DA, Kwon O. Janus kinase inhibitors: an innovative treatment for alopecia areata. J Dermatol. 2019;46(8):724-30.

Sonthalia S, Aggarwal P. Oral tofacitinib: contemporary appraisal of its role in dermatology. Indian Dermatol Online J. 2019;10(5):503-18.

Serdaroğlu S, Engin B, Çelik U, Erkan E, Aşkın Ö, Oba Ç, et al. Clinical experiences on alopecia areata treatment with tofacitinib: A study of 63 patients. Dermatol Ther. 2019;32(3):e12844.

Crispin KM, Ko JM, Craiglow BG, Li S, Shankar G, Urban JR, et al. Safety and efficacy of the JAK inhibitor tofacitinib citrate in patients with alopecia areata. JCI Insight. 2016;1(15):e89776.

Asilian A, Mohammadian P, Shahmoradi Z. Effectiveness of oral tofacitinib treatment on patients with moderate-to-severe alopecia areata in Iran. J Cosmet Dermatol. 2024;23:886-90.

Esteves M, Lopes S, Azevedo F, Pedrosa A. Effectiveness of oral tofacitinib dose tapering in a case of alopecia areata universalis. Dermatology. 2021;7:36-40.

Ibrahim O, Bayart CB, Hogan S, Piliang M, Bergfeld WF. Treatment of alopecia areata with tofacitinib. JAMA Dermatol. 2017;153:600-2.

Rota DD, Emeksiz MAC, Erdogan FG, Yildirim D. Experience with oral tofacitinib in severe alopecia areata with different clinical responses. J Cosmet Dermatol. 2021;20(9):3026-33.