Efficacy of tofacitinib in treatment of alopecia universalis in two patients

• Published in: Journal of the European Academy of Dermatology and Venereology 2016-08, Vol.30 (8), p.1373-1378
• Main Authors: Gupta, A.K., Carviel, J.L., Abramovits, W.
• Format: Article
• Language: English
• Subjects: Adult; Alopecia - drug therapy; Alopecia - immunology; Humans; Male; Piperidines - therapeutic use; Pyrimidines - therapeutic use; Pyrroles - therapeutic use; Treatment Outcome
• ISSN: 0926-9959; 1468-3083
• DOI: 10.1111/jdv.13598

Background Autoimmune‐triggered non‐scarring hair loss is a feature of alopecia areata (AA). Initially patchy and often self‐limited, severe hair loss forms include the complete loss of scalp hair or alopecia totalis (AT) and complete loss of all hair or alopecia universalis (AU). For AT and AU a reliable treatment has remained elusive. The targeted kinase inhibitor tofacitinib, in current use for treatment of other immune diseases, has been hypothesized as a viable option for AA, AT and AU therapy and a few case reports support this. Objective Our study aims to provide evidence for the effectiveness of tofacitinib in the treatment of AU. Methods Two patients diagnosed with long‐term AU were prescribed tofacitinib citrate at a dosage of 5 mg twice daily and observed for eight months. Results In the first patient, beard growth was significant by 3 months of treatment. By 6 months of treatment, hair growth was apparent throughout the entire body. By 8 months of treatment, scalp hair continued to grow longer and thicker. In addition, eyelashes and eyebrows were established. In the second patient, a noticeable increase in scalp hair was present just 1 month into treatment. By 4 months into treatment, significant scalp regrowth was observed as well as eyelash, eyebrow and beard regrowth. Axillary hair regrowth and isolated leg hair was noted by 8 months. Conclusion In our patients, tofacitinib successfully alleviated AU in the absence of significant adverse side‐effects. We recommend that further study be required to establish safety and confirm efficacy.