Real‐world experience and long‐term evaluation of tofacitinib in refractory alopecia areata: A prospective, open‐label, single‐center study in Asian Arab population

Abstract

Tofacitinib is a pan-janus kinase inhibitor (JAK) which has been tested off-label in alopecia areata (AA) with promising results. However, evidence of tofacitinib in real-life setting is still poor. We evaluated long-term efficacy and safety of tofacitinib for refractory AA. This is a prospective, open-label, observational, single-center cohort study conducted between January 2018 and December 2020. Primary end-point was the percent change in Severity of Alopecia Tool (SALT) at the basal visit and at the most recent follow-up visit. Three categories of treatment response were analyzed.Data on 47 participants of Arab-Asian heritage were analyzed. A complete and partial regrowth was observed in 18 patients (41.86%) and 11 patients (25.58%), respectively. In 12 patients (27.9%), no response was obtained. Most of the non-responders belonged to the alopecia universalis group (66.67%). No statistical differences were observed in rates of regrowth between pediatric and adult individuals (p = 0.52), nor between women and men. Significant differences in the average duration of tofacitinib treatment were obtained among the three categories of regrowth (p < 0.003), notably duration of AA did not impact the clinical regrowth (p = 0.62). To the best of our knowledge, this is the first prospective, observational, long-term study using tofacitinib in refractory AA. Rates of regrowth and side effects are analogous to previous works. Length of tofacinitib therapy should last for 12 months before considering any discontinuation or change, since early cessation can lead to treatment failures or incomplete regrowth. Maintenance therapy after complete regrowth has demonstrated to be safe and effective to prevent recurrences of hair loss.

Systemic Tofacitinib Treatment in Pediatric Patients with Resistant Alopecia Areata

“…Guo et al conducted a comprehensive analysis, incorporating six clinical trials and eight observational studies, and found that 54.0% of 275 patients showcased good or full response, with 26.1% displaying partial response [13]. In a prospective study by Husein-ElAhmed, encompassing an Asian Arab population, 41.86% experienced complete remission and 25.58% achieved partial remission among 47 patients, with a comparable regrowth rate between pediatric and adult individuals [14]. Despite limited studies involving pediatric cases, Craiglow et al's case series exhibited signifcant hair regrowth in 9 of 13 patients [15].…”

Efficacy of Janus kinase inhibitors in adult patients with alopecia areata

“…Additionally, maintenance therapy after complete regrowth proved to be effective and safe in preventing hair loss recurrence. 22 In a retrospective pilot study that 13 patients with severe AA, all three patients with AA responded well to treatment, while 50% of patients with alopecia universalis did not achieve successful treatment outcomes. 23 Furthermore, a large retrospective study involving 90 AA patients found that among 65 potential responders (patients with alopecia totalis or alopecia universalis experiencing the current episode of the disease for ten years or less), approximately 77% achieved a clinical response.…”

“…Tofacitinib, a JAKis has shown varying response rates in the treatment of AA, which can be influenced by study design and patient populations. 22 In a prospective, open-label, observational, single-center cohort study involving 47 Arab-Asian patients with refractory AA, approximately 42% of the participants experienced complete regrowth of hair, while 25.58% achieved partial regrowth. On the other hand, 27.9% did not respond to the treatment.…”

Effectiveness and safety of baricitinib in patients with moderate‐to‐severe refractory alopecia areata in real world: An open‐label, single‐center study

“…Although spontaneous regrowth is possible in some patients, many patients, especially patients with severe AA, have no response to the treatments including minoxidil and glucocorticoids. In other words, alopecia can be very refractory in these patients 4–7 . In recent years, with the development in the pathogenesis research of AA, JAK inhibitors have demonstrated promising effectiveness in treating moderate‐to‐severe AA 8 .…”

“…words, alopecia can be very refractory in these patients. [4][5][6][7] In recent years, with the development in the pathogenesis research of AA, JAK inhibitors have demonstrated promising effectiveness in treating moderate-to-severe AA. 8 However, few previous studies have focused on the effectiveness of baricitinib in patients who react poorly to other AA therapies.…”