Evaluation of the alopecia areata patients on tofacitinib treatment during the COVID‐19 pandemic

Abstract

Tofacitinib is a Janus Kinase 3 inhibitor that is used in the treatment of alopecia areata. We recommended our alopecia areata patients to discontinue their tofacitinib treatment during the COVID‐19 pandemic for an average of 80 days. We aimed to evaluate the drug use and the SARS‐CoV‐2 infection status of alopecia areata patients; and the relationships of recurrence to age, gender, treatment duration, and tofacitinib discontinuation. One‐hundred and ninety‐one (61.4%) patients were off the drug and 120 (38.6%) were on therapy during the pandemic. The relationship between drug discontinuation due to the COVID‐19 pandemic and recurrence was statistically significant ( P < .001). Statistically significant relationships of age ( P = .013) and treatment duration ( P < .001) to recurrence were also found. The change in the SALT score differed between the patients on therapy and off therapy during the pandemic ( P < .001). A significant negative correlation was found between the change in the SALT score and treatment duration: the spearman correlation test P = .018. We concluded that the patients may continue to the tofacitinib therapy during the rest of the COVID‐19 pandemic if the benefit outweighed the risk.

The signal pathways and treatment of cytokine storm in COVID-19

“… 327 , 328 In addition, considering the general immunosuppressive nature, some researchers are concerned that continuous treatment with JAKinibs for autoimmune diseases may increase the risk of SARS-CoV-2 infections or contribute to poor outcomes in COVID-19. Hence, several retrospective clinical trials have been conducted to address these concerns; 329 – 334 (2) critical COVID-19 is commonly accompanied by coagulopathy and thrombosis, and the Food and Drug Administration has warned that administration of some JAKinibs has increased the risk of thrombosis. 335 Thus, developing JAKinibs with better specificity could be a future direction of research aimed to prevent/reduce CS and improve the survival of COVID-19 patients.…”

Tofacitinib Treatment in Patients With Active COVID-19 Infection

“…With the recent COVID-19 pandemic, it has been advised to discontinue immunosuppressive medications, including tofacitinib, during active COVID-19 infection due to the possible alteration of the immune response by these drugs, which could worsen the course of the infection [2]. Conversely, it has been reported that a 33-year-old woman with ulcerative colitis (UC) who was controlled on tofacitinib 10 mg twice daily had acquired the COVID-19 infection, and she continued to use tofacitinib during her illness without interruption.…”

“…Despite that, her respiratory symptoms resolved in five days, and she recovered completely in two weeks with no change to tofacitinib treatment [7]. In addition, other studies have investigated the use of tofacitinib and other JAK inhibitors on the outcomes of COVID-19 infection and have concluded that there is no statistically significant difference in the rate of hospitalization, admission to the ICU, and severe COVID-19 infection among tofacitinib-treated patients and other patients [8,2]. In fact, a recently published systematic review sheds light on the potential efficacy of JAK inhibitors and Type I interferons against the COVID-19 infection and its association with positive clinical outcomes in terms of hospitalization, ICU admission, and mortality rate [9].…”

“…Tofacitinib is an effective JAK1 and JAK3 inhibitor that can block several cytokines such as IL-2, IL-7, and IL-6 [3]. With the recent COVID-19 pandemic, it has been advised to withhold JAK inhibitors during the period of active infection due to possible immunosuppression [2]. We herein report two cases of patients with alopecia universalis who continued to use tofacitinib during their active COVID-19 infection and showed no deterioration in their course of illness.…”

“…Genetic predisposition and autoimmunity play an important role in the pathogenesis of alopecia; however, other factors such as psychological distress can also trigger the disease. It has been found that Janus kinase 3 (JAK3) hyperactivity plays a key role in the pathogenesis of the disease [2]. Hence, the introduction of JAK inhibitors into the management of alopecia has made a great impact on alopecia-affected patients.…”