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

In a 2017 study involving 90 patients with severe alopecia areata (AA), alopecia totalis (AT), or alopecia universalis (AU), tofacitinib, a Janus kinase inhibitor, was found to be effective and well-tolerated. The study reported a 77% clinical response rate, with 58% of patients achieving greater than 50% improvement in Severity of Alopecia Tool (SALT) score over 4 to 18 months. Patients with AA had a higher response rate compared to those with AT/AU. The most common side effects included upper respiratory infections, headache, acne, and fatigue, but no serious adverse events were reported. The study suggested that the likelihood of complete hair regrowth decreases with the duration of hair loss, especially after 10 years, and maintenance therapy might be necessary for sustained remission. The study's limitations included its retrospective nature, small sample size, and lack of a control group, and it recommended randomized controlled trials for further investigation.