Alopecia areata and tofacitinib: a prospective multicenter study from a Saudi population

Abstract

Background Alopecia areata (AA) is an autoimmune disorder characterized by nonscarring hair loss that can involve the scalp, face, and body. Severe AA subtypes have a poorer prognosis and can be challenging to treat. Tofacitinib, a recently introduced Janus kinase inhibitor, has shown positive results in treating AA. This multicenter study demonstrates the efficacy of tofacitinib and the patient response rate in a Saudi population.It also highlights patient characteristics that may serve as predictors of the therapeutic response to tofacitinib. Methods A prospective cohort study design was utilized. Study participants were included from three medical centers in Riyadh, Saudi Arabia. The Severity of Alopecia Tool (SALT) score was used to assess the percentage of hair loss at baseline and the percentage of hair regrowth at 3 and 6 months. ResultsThe sample size was 68 with an average baseline SALT score of 76.8 AE 27.6%.Data at 6 months were available for 45 patients. Of these, 62.2% achieved a SALT score of >50%. Patients with a score of <50% had a significantly higher baseline SALT score compared to patients with >50% score. The past use of systemic steroids was associated with a diminished response to therapy (P = 0.015). The response to therapy was significantly higher in patients with AA compared to alopecia totalis and alopecia universalis.Conclusions Tofacitinib is an effective and well-tolerated treatment for severe AA and exhibits a good safety profile.

Systematic review of newer agents for the management of alopecia areata in adults: Janus kinase inhibitors, biologics and phosphodiesterase‐4 inhibitors

“…However, at a subsequent 3‐month follow‐up after stopping the treatment, 70.2% (26/37) of the patients experienced relapse (hair loss >25%) 28 . Similar findings were also observed in previous studies with or without treatment relapses 33–37 …”

“…28 Similar findings were also observed in previous studies with or without treatment relapses. [33][34][35][36][37]…”

The efficacy and safety of JAK inhibitors for alopecia areata: A systematic review and meta-analysis of prospective studies

“…The remaining 151 potentially relevant reports were reviewed in full text. After detailed evaluation of these reports, 14 studies (5 RCTs and 9 non-RCTs) ( Kennedy Crispin et al, 2016 ; Mackay-Wiggan et al, 2016 ; Almutairi et al, 2018 ; Jabbari et al, 2018 ; Liu et al, 2018 ; Olsen et al, 2020 ; King et al, 2021a ; AlMarzoug et al, 2021 ; King et al, 2021b ; Lai et al, 2021 ; Peeva et al, 2021 ; King et al, 2022 ), enrolling a total of 1,845 patients, were included for analysis ( Figure 1 ).…”

“…Among the included 5 RCTs, 3 compared oral baricitinib with placebo ( King et al, 2021b ; King et al, 2022 ), 1 compared oral ritlecitinib and brepocitinib with placebo ( King et al, 2021a ), and 1 compared topical ruxolitinib with placebo ( Olsen et al, 2020 ). Among the included 9 non-RCTs, 7 single-arm clinical trials evaluated the efficacy and safety of oral/topical ruxolitinib and oral/topical/sublingual tofacitinib ( Kennedy Crispin et al, 2016 ; Mackay-Wiggan et al, 2016 ; Jabbari et al, 2018 ; Liu et al, 2018 ; Olsen et al, 2020 ; AlMarzoug et al, 2021 ; Lai et al, 2021 ), 1 study of extension periods of RCT investigated the maintenance and withdrawal with oral ritlecitinib and brepocitinib ( Peeva et al, 2021 ), and 1 non-randomized controlled trial compared oral ruxolitinib with oral tofacitinib ( Almutairi et al, 2018 ).…”

Safety of Janus Kinase inhibitors in Patients with Alopecia Areata: A Systematic Review

“…Elevated liver enzymes were reported in 5.2% [ 18 ], 4.3% [ 14 ], 2.7% [ 12 , 18 , 20 – 22 , 24 , 32 , 36 , 37 ], and 1.0% [ 13 ] of adults treated with oral ruxolitinib, brepocitinib, tofacitinib, and deuruxolitinib, respectively. In children treated with oral and topical tofacitinib, liver enzymes were elevated in 14.5% [ 26 , 38 , 39 ] and 6.7% [ 40 ] of cases, respectively.…”