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

The retrospective cohort study evaluated the safety and efficacy of tofacitinib, a Janus kinase 1/3 inhibitor, in 90 patients aged 18 or older with severe alopecia areata (AA) and variants, who had at least 40% scalp hair loss. The primary endpoint was the percent change in Severity of Alopecia Tool (SALT) score during treatment. Of the 65 potential responders (those with a current disease episode of 10 years or less), 77% achieved a clinical response, with 58% of patients achieving greater than 50% change in SALT score over 4-20 months of treatment. Patients with AA experienced a higher percent change in SALT score than those with alopecia totalis (AT) or alopecia universalis (AU) (81.9% vs 59.0%). Tofacitinib was well tolerated with no serious adverse events reported. The study concluded that tofacitinib should be considered for the treatment of severe AA, AT, and AU, despite limitations such as its retrospective nature, the relatively small number of patients, and the lack of a control group.