TLDR Tofacitinib is safe and effective for severe alopecia areata, but hair loss may return 2 months after stopping treatment.
In a study conducted from July 2014 to March 2015, 66 patients with alopecia areata (AA), including alopecia totalis (AT) and alopecia universalis (AU), were treated with 5 mg of tofacitinib citrate twice daily for 3 months. The study found that 64% of patients responded to treatment, with 32% achieving a 50% or greater improvement in their Severity of Alopecia Tool (SALT) score. AA and ophiasis subtypes had a better response compared to AT and AU subtypes. A negative correlation was observed between the duration of AA and the percentage change in SALT score. Adverse events were mostly mild infections. The study concluded that tofacitinib is a safe and effective treatment for severe AA, but the effects were not long-lasting, with hair loss recurring approximately 2 months after treatment cessation. Additionally, molecular profiling was used to predict treatment response, with gene expression signatures differentiating between true nonresponders, slow responders, and true responders. Safety monitoring revealed one case of elevated liver enzymes and average increases in cholesterol levels.
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