Alopecia areata is an autoimmune disease characterized by hair loss mediated by CD8+ T cells. There are no reliably effective therapies for alopecia areat . Based on recent developments in the understanding of the pathomechanism of alopecia areata, JAK inhibitors appear to be a therapeutic option; however, their efficacy for the treatment of alopecia areata has not been systematically examined.
This was a 2-center, open-label, single-arm trial using the pan-JAK inhibitor, Tofacitinib citrate ( Xeljanz ), for alopecia areata with more than 50% scalp hair loss, alopecia totalis, and alopecia universalis.
Tofacitinib ( 5 mg ) was given twice daily for 3 months.
Endpoints included regrowth of scalp hair, as assessed by the severity of alopecia tool ( SALT ), duration of hair growth after completion of therapy, and disease transcriptome.
Of 66 subjects treated, 32% experienced 50% or greater improvement in SALT score.
Alopecia areata and ophiasis subtypes were more responsive than alopecia totalis and alopecia universalis subtypes.
Shorter duration of disease and histological peribulbar inflammation on pretreatment scalp biopsies were associated with improvement in SALT score.
Drug cessation resulted in disease relapse in 8.5 weeks.
Adverse events were limited to grade I and II infections.
An alopecia areata responsiveness to JAK/STAT inhibitors score was developed to segregate responders and non-responders, and the previously developed alopecia areata disease activity index score tracked response to treatment.
In conclusion, at the dose and duration studied, Tofacitinib is a safe and effective treatment for severe alopecia areata, though it does not result in a durable response.
Transcriptome changes reveal unexpected molecular complexity within the disease. ( Xagena )
Kennedy Crispin M et al, JCI Insight 2016; 1(15):e89776