Tofacitinib for the Treatment of Severe Alopecia Areata in Adults and Adolescents

The document reviews the use of tofacitinib, a Janus kinase inhibitor, for treating severe alopecia areata (AA) in adults and adolescents. In an open-label clinical trial involving 66 patients with severe AA, alopecia totalis (AT), or alopecia universalis (AU), tofacitinib administered at 5 mg twice daily for 3 months resulted in a median improvement in the Severity of Alopecia Tool (SALT) score of 21%. About 64% of patients experienced some hair regrowth, and 32% achieved an improvement in SALT score of greater than 50%. However, all 20 patients who were followed up experienced disease relapse within a median of 8.5 weeks after stopping treatment. A retrospective cohort study of 90 adults showed that 77% of potential responders (those with AT or AU of less than 10 years duration or AA) achieved some hair regrowth, with 58% achieving over 50% improvement and 20% achieving full regrowth. In adolescents, a study of 13 patients treated with tofacitinib for 2-16 months resulted in a 93% median improvement in SALT score, with 9 patients experiencing hair regrowth. Adverse events in these studies were generally mild and included infections and headaches. The document concludes that targeted therapy for severe AA is within reach, with tofacitinib showing promise in both adults and adolescents.