Role of Janus Kinase Inhibitors in the Treatment of Alopecia Areata

July 2018 in “ Drug design, development and therapy ”

Korn Triyangkulsri, Poonkiat Suchonwanit

alopecia areata janus kinase inhibitors JAKis tofacitinib ruxolitinib baricitinib T-cell-mediated inflammatory responses AA JAK inhibitors

From the encyclopedia

Alopecia Areata →

autoimmune disorder causing patchy hair loss

Tofacitinib →

a JAK inhibitor for alopecia areata and other autoimmune conditions

Baricitinib →

JAK inhibitor that reduces inflammation and immune attacks on hair follicles, leading to potential hair regrowth, especially in alopecia areata cases

Studysummary This review summarizes existing evidence on the efficacy and safety of JAK inhibitors for treating alopecia areata and emphasizes the need for improved topical formulations.

Our plain-language summary. Not medical advice or a treatment recommendation. Consult a qualified healthcare professional before changing treatment. Full disclaimer

The document reviewed the role of Janus kinase (JAK) inhibitors in treating alopecia areata (AA), an autoimmune condition causing hair loss. It highlighted that JAK inhibitors like tofacitinib and ruxolitinib showed promise in promoting hair regrowth, with studies reporting significant improvements in many patients. For example, a study with 90 patients treated with tofacitinib showed 20% were complete responders and 38.4% were intermediate responders. However, hair loss often recurred after stopping treatment, and side effects included infections and liver enzyme elevations. The document emphasized the need for further research to confirm long-term efficacy and safety.

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Research cited in this study

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An Open-Label Pilot Study to Evaluate the Efficacy of Tofacitinib in Moderate to Severe Patch-Type Alopecia Areata, Totalis, and Universalis

research An Open-Label Pilot Study to Evaluate the Efficacy of Tofacitinib in Moderate to Severe Patch-Type Alopecia Areata, Totalis, and Universalis

130 citations , February 2018 in “Journal of Investigative Dermatology”

This study found that tofacitinib led to ≥50% hair regrowth in eight out of twelve patients with moderate to severe alopecia areata, suggesting a potential benefit for using JAK inhibitors in treating this condition.

research Tofacitinib 2% Ointment, a Topical Janus Kinase Inhibitor, for the Treatment of Alopecia Areata: A Pilot Study of 10 Patients

48 citations , November 2017 in “Journal of the American Academy of Dermatology”

Tofacitinib 2% ointment helped hair regrow in 3 out of 10 patients with alopecia areata, but caused side effects like scalp irritation and raised cholesterol in some.

$Oral Tofacitinib Monotherapy in Korean Patients with Refractory Moderate-to-Severe Alopecia Areata: A Case Series$

research Oral Tofacitinib Monotherapy in Korean Patients with Refractory Moderate-to-Severe Alopecia Areata: A Case Series

44 citations , October 2017 in “Journal of the American Academy of Dermatology”

In this study, tofacitinib monotherapy was effective in achieving hair regrowth in over half of Korean patients with moderate-to-severe and refractory alopecia areata, though treatment discontinuation typically led to hair loss recurrence.

research Complete Regrowth of Beard Hair with Ruxolitinib in an Alopecia Universalis Patient

22 citations , September 2017 in “Skin appendage disorders”

This report describes a case where treatment with the JAK inhibitor ruxolitinib significantly improved beard growth in a patient with severe alopecia areata, emphasizing its potential benefits for populations where beard hair holds cultural significance.

research Efficacy of Topical Tofacitinib in Promoting Hair Growth in Non-Scarring Alopecia: Possible Mechanism via VEGF Induction

27 citations , September 2017 in “Archives of Dermatological Research”

In this study, topical tofacitinib significantly increased hair regrowth in mice compared to minoxidil or vehicle, potentially due to elevated VEGF levels and reduced inflammation.

research Brazilian Experience of Treating Alopecia Universalis with Novel Antirheumatic Therapy Tofacitinib: A Case Series

16 citations , July 2017 in “Rheumatology and Therapy”

This review examines the outcomes of treating Brazilian patients with alopecia universalis using tofacitinib and highlights the need for randomized controlled trials to determine optimal dosing and duration.

research Ruxolitinib Found to Cause Eyelash Growth: A Case Report

9 citations , July 2017 in “Journal of medical case reports”

This study reports the first case of eyelash elongation and thickening in a patient with hypereosinophilic syndrome taking the Janus kinase inhibitor ruxolitinib.

research A Case of Topical Ruxolitinib Treatment Failure in Alopecia Areata

30 citations , June 2017 in “Journal of cutaneous medicine and surgery”

This study reports that topical ruxolitinib failed to induce hair growth in a 66-year-old patient with alopecia areata, highlighting the need to explore factors affecting treatment response and compare topical vs oral administration outcomes.

research Topical Janus Kinase Inhibitors for the Treatment of Pediatric Alopecia Areata

83 citations , June 2017 in “Journal of the American Academy of Dermatology”

This study observed that most pediatric patients with alopecia areata experienced some hair regrowth after treatment with topical JAK inhibitors, and the formulations were generally well-tolerated with mild lab abnormalities in some cases.

research Successful Hair Regrowth in a Korean Patient with Alopecia Universalis Following Tofacitinib Treatment

8 citations , May 2017 in “Singapore Medical Journal”

A Korean woman with complete hair loss regrew her hair after taking tofacitinib, with no side effects.

research Treatment of Alopecia Areata With Tofacitinib

78 citations , March 2017 in “JAMA Dermatology”

Tofacitinib helped regrow hair in people with severe alopecia, but side effects occurred and benefits stopped after treatment ended.

research Two Cases of Alopecia Areata Treated with Ruxolitinib: A Discussion of Ideal Dosing and Laboratory Monitoring

25 citations , March 2017 in “International Journal of Dermatology”

In this case report, two women with chronic alopecia areata and acute alopecia universalis experienced sustained and near-complete hair regrowth after over a year of treatment with oral ruxolitinib, without significant side effects.

research Experience with Oral Tofacitinib in 8 Adolescent Patients with Alopecia Universalis

49 citations , March 2017 in “Journal of the American Academy of Dermatology”

This case series found that oral tofacitinib treatment in eight adolescents with alopecia universalis led to significant regrowth of hair, though relapse is likely after stopping therapy.

research Alopecia Universalis Unresponsive to Treatment with Tofacitinib: Report of a Case with a Brief Review of the Literature

8 citations , January 2017 in “Dermatology online journal”

This case study reports that tofacitinib led to remission of psoriasis but did not improve alopecia universalis in one patient, suggesting varied responses in treating such conditions.

research Excellent Response to Tofacitinib Treatment in a Patient with Alopecia Universalis

16 citations , January 2017 in “Acta dermatovenerologica Alpina, Pannonica et Adriatica (Tiskana izd.)”

This case study reports that a 23-year-old woman with alopecia universalis experienced complete hair regrowth after six months of treatment with tofacitinib, a JAK-3 inhibitor.

research Tofacitinib for the Treatment of Alopecia Areata and Variants in Adolescents

139 citations , November 2016 in “Journal of the American Academy of Dermatology”

In this retrospective review, tofacitinib treatment was associated with clinically significant hair regrowth in most adolescent patients with alopecia areata, though limitations suggest further studies are needed to confirm these findings.

research Tofacitinib for the Treatment of Severe Alopecia Areata and Variants: A Study of 90 Patients

238 citations , November 2016 in “Journal of The American Academy of Dermatology”

In this study, tofacitinib was reported to improve scalp hair regrowth in patients with severe alopecia areata, alopecia totalis, and alopecia universalis, showing a higher response in alopecia areata.

research Remarkable Improvement of Nail Changes in Alopecia Areata Universalis with 10 Months of Treatment with Tofacitinib: A Case Report

26 citations , October 2016 in “Case Reports in Dermatology”

In this study, tofacitinib treatment in a male patient with alopecia areata led to significant hair regrowth and improvement in nail dystrophy symptoms, restoring finger function within 10 months.

research Safety and Efficacy of the JAK Inhibitor Tofacitinib Citrate in Patients with Alopecia Areata

222 citations , September 2016 in “JCI insight”

This research overview highlights that although JAK inhibitors show promise as potential treatments for alopecia areata based on recent insights into the disease mechanism, their efficacy has not yet been thoroughly evaluated in a systematic manner.

research Oral Ruxolitinib Induces Hair Regrowth in Patients with Moderate-to-Severe Alopecia Areata

196 citations , September 2016 in “JCI insight”

This study explored the effectiveness of the oral JAK1/2 inhibitor ruxolitinib in treating patients with moderate-to-severe alopecia areata, building on prior success with JAK inhibitors in mice, but results are not reported in this abstract.

$Successful Treatment of Refractory Alopecia Areata Universalis and Psoriatic Arthritis, But Not Plaque Psoriasis with Tofacitinib in a Young Woman$

research Successful Treatment of Refractory Alopecia Areata Universalis and Psoriatic Arthritis, But Not Plaque Psoriasis with Tofacitinib in a Young Woman

24 citations , June 2016 in “Acta dermato-venereologica”

In this case report, tofacitinib was associated with new hair growth on psoriasis lesions after three months of treatment.

research Efficacy of Tofacitinib in Treatment of Alopecia Universalis in Two Patients

51 citations , June 2016 in “Journal of the European Academy of Dermatology and Venereology”

In this study, tofacitinib treatment was associated with significant hair regrowth in two patients with alopecia universalis over eight months, with minimal adverse effects reported.

research Familial Aggregation of Alopecia Areata

295 citations , May 2016 in “Journal of the American Academy of Dermatology”

This review examines the immunological aspects of alopecia areata, focusing on genetic, neuroimmunological, and immune privilege factors, but does not report new clinical findings.

research Treatment of an Alopecia Areata Patient with Tofacitinib Results in Regrowth of Hair and Changes in Serum and Skin Biomarkers

70 citations , April 2016 in “Experimental Dermatology”

In this study, oral tofacitinib treatment led to significant hair regrowth and changes in skin and blood biomarkers in a patient with alopecia areata.

research Topical Ruxolitinib for the Treatment of Alopecia Universalis

96 citations , December 2015 in “JAMA dermatology”

This article discusses the potential of topical ruxolitinib as a treatment for alopecia universalis and acknowledges the need for alternatives to systemic JAK inhibitors due to the risk of serious side effects.

research Tofacitinib Citrate for the Treatment of Nail Dystrophy Associated with Alopecia Universalis

41 citations , December 2015 in “JAMA Dermatology”

Tofacitinib citrate improved nail dystrophy and pain in patients with alopecia universalis without causing side effects.

research Pharmacologic Inhibition of JAK-STAT Signaling Promotes Hair Growth

159 citations , October 2015 in “Science Advances”

This study observed that applying JAK-STAT pathway inhibitors to mouse and human skin led to rapid hair growth by inducing the anagen phase of hair follicles.

research Reversal of Alopecia Areata Following Treatment With the JAK1/2 Inhibitor Baricitinib

184 citations , February 2015 in “EBioMedicine”

This study observed that baricitinib treatment led to significant improvement in a patient's alopecia areata symptoms and suggests further clinical trials to explore its potential as a treatment.

research The Autoimmune Basis of Alopecia Areata: A Comprehensive Review

162 citations , October 2014 in “Autoimmunity reviews”

This review discusses alopecia areata, highlighting its autoimmune aspects, environmental triggers, and current treatment options, but reports no new clinical results; recent studies suggest JAK pathway intervention may offer therapeutic potential.

research Inhibiting Janus Kinases to Treat Alopecia Areata

52 citations , September 2014 in “Nature medicine”

JAK inhibitors might help treat alopecia areata.

research Alopecia Areata Is Driven by Cytotoxic T Lymphocytes and Is Reversed by JAK Inhibition

701 citations , August 2014 in “Nature medicine”

This study found that JAK inhibitors promote hair regrowth in both mice and human alopecia areata cases by blocking key immune pathways involved in disease development.

research Killing Two Birds with One Stone: Oral Tofacitinib Reverses Alopecia Universalis in a Patient with Plaque Psoriasis

185 citations , June 2014 in “Journal of Investigative Dermatology”

This case report describes complete hair regrowth in a patient with alopecia universalis and improved psoriasis after treatment with the oral Janus kinase inhibitor, tofacitinib.

research The Role of Hair Follicle Immune Privilege Collapse in Alopecia Areata: Status and Perspectives

79 citations , December 2013 in “Journal of Investigative Dermatology Symposium Proceedings”

This article proposes that alopecia areata may be caused by immune attacks on hair follicles after an immune privilege collapse, suggesting new therapeutic approaches targeting this immune response pattern.

research Dihydrotestosterone-Inducible IL-6 Inhibits Elongation of Human Hair Shafts by Suppressing Matrix Cell Proliferation and Promotes Regression of Hair Follicles in Mice

173 citations , September 2011 in “Journal of Investigative Dermatology”

IL-6 contributes to hair loss by shortening the growth phase and causing hair follicles to regress.

research Genome-Wide Association Study in Alopecia Areata Implicates Both Innate and Adaptive Immunity

717 citations , June 2010 in “Nature”

This study identified key genetic regions associated with alopecia areata, highlighting both acquired and innate immune involvement, with a novel link to the upregulation of ULBP ligands in autoimmune disease.

research Maintenance of Hair Follicle Immune Privilege Is Linked to Prevention of NK Cell Attack

253 citations , December 2007 in “Journal of Investigative Dermatology”

This study suggests that human hair follicles may actively suppress natural killer cells, which contrasts with the observed defects in NK cell regulation in alopecia areata.

research Genomewide Scan for Linkage Reveals Evidence of Several Susceptibility Loci for Alopecia Areata

143 citations , January 2007 in “The American Journal of Human Genetics”

This study identified four genetic loci on chromosomes 6, 10, 16, and 18 that may contribute to susceptibility for alopecia areata and suggested shared genetic factors with psoriasis.

research Histopathology of Non-Scarring Alopecia

122 citations , April 1995 in “Journal of Cutaneous Pathology”

The document describes how to tell different types of non-scarring hair loss apart by looking at hair and scalp tissue under a microscope.

research Interleukin 6: Insights Into Its Function in Skin by Overexpression in Transgenic Mice

221 citations , June 1992 in “Proceedings of the National Academy of Sciences”

In this study, IL-6 expression in transgenic mice thickened the stratum corneum without causing increased epidermal proliferation or inflammation, suggesting it may enhance skin protection rather than directly induce inflammation.