The Efficacy and Safety of Tofacitinib in Patients with Alopecia Totalis

    August 2018 in “ Journal of the American Academy of Dermatology ”
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    TLDR Tofacitinib is a potential alternative treatment for alopecia totalis, especially in patients with a shorter duration of the condition and more preserved hair follicles, but the overall response rate is low.
    The study titled "The efficacy and safety of tofacitinib in patients with alopecia totalis" involved a prospective open label study of 9 patients with recalcitrant alopecia totalis (AT), who were unresponsive to other treatments and took 5 mg of tofacitinib twice daily for 6 months. The efficacy was measured by the percent change in Severity of Alopecia Tool (SALT) score. At the 6-month endpoint, 3 patients (33.3%) experienced 25% to 75% hair regrowth and were considered responders, while the remaining 6 were nonresponders. Responders had a later age of onset (mean 21 years) and shorter duration of current AA episode (mean 4 years) compared to nonresponders (mean onset at 9.2 years and duration of 14 years). Histopathologic examination showed reduced hair follicle number and miniaturization in nonresponders. Tofacitinib was well tolerated with no significant adverse events. The study concluded that patients with a shorter duration of current AT and more preserved hair follicles responded better to tofacitinib, suggesting it as an alternative treatment for recalcitrant AT despite an overall unsatisfactory response rate.
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