Tofacitinib Effective for AA, Earlier Intervention Improves Outcomes

Before and after hair regrowth, rear view of male head | Image Credit: Sebastian - stock.adobe.com

A recent study found tofacitinib effective in patients with alopecia areata (AA) and highlighted predictive factors of response to the treatment. The findings also suggest that earlier intervention in severe AA leads to better outcomes.

Tofacitinib was the first clinically approved Janus kinase (JAK) inhibitor prior to baricitnib and ritlecitinib. While it is studied more extensively compared with the other 2 drugs and has shown clinical efficacy in several studies, there have not been any prospective randomized controlled trials of tofacitinib in alopecia areata, according to the study authors.

Therefore, the researchers conducted a retrospective cohort study at a dermatology clinic at Xiangya Hospital in China between February 2021 and December 2022. There were a total of 125 patients with AA, including 48 males and 77 females. Of the enrolled patients, patchy AA was the most common subtype, and topical drugs were the most common form of prior treatment in patients (n = 91, n= 106, respectively).

Over the course of 3 months, patients received 5 mg of tofacitinib twice a day if they were more than 88 lbs or 5 mg daily if they were under 88 lbs. The primary outcome of the study was the overall change in AA severity as evaluated by the Severity of Alopecia Tool (SALT) grading. Results were categorized as either complete remission (CR), partial remission (PR), ineffectiveness, or deterioration.

Univariate and multivariate analyses were conducted to calculate predictive factors associated with response to tofacitinib treatment in patients with AA. These included the total duration of AA (OR = .442; P = .091), severity of AA (OR = 2.641; P = .052), and previous hair regrowth (OR = 2.406; P = .092). After alterations in a multivariable model, longer duration of AA was an independent predictive factor negatively affecting response (adjusted OR = .193; P = .011), suggesting earlier treatment may lead to better outcomes. AA severity and previous hair regrowth were significant predictors associated with a better outcome ([adjusted OR = 3.415; P = .026] and [adjusted OR = 5.312; P = .010], respectively).

A total of 20 patients achieved SALT grade 0 after the 3-week follow-up period. Prior to treatment, most patients were S5, but afterwards, most patients were considered S2. Overall, the number patients with S3 or higher reduced from 93 to 34, with only 1 patient remaining in S5.

Overall, 83.2% of patients (n = 104) with AA experienced a response to treatment, with 16% (n = 20) experiencing CR. However, 16% of patients (n = 20) did not respond to treatment, and 1 patient's condition worsened. Drug administration was halted in 33 patients once they reached CR, with 23 of them followed for more than 3 months. Within 3 months, 12 patients relapsed, and 5 patients experienced an exacerbation within 1 month.

Patients who experienced adverse events reported mild, controllable folliculitis, acne, and headaches.

The study was limited by its small sample size, short follow-up period and the use of single-center clinical data. Tofacitinib was not compared with other drugs in efficacy or tolerability in the study, and its efficacy for hair loss on other body parts was not described. Prognostic factors such as vitamin D and immunoglobulin E were also not recognized within the study. Finally, severity of AA is measured with SALT grading rather than score, which likely underestimates the effect tofacitinib and influences the results to some extent.

Authors concluded, “the current study further demonstrated the effectiveness of tofacitinib treatment in patients with AA and these data will provide insights into how to improve care for patients with AA flares and support physicians in making informed treatment and management decisions.”

Reference

Huang J, Qian P, Tang Y, Li J, Liu F, Shi W. Effectiveness and predictive factors of response to tofacitinib therapy in 125 patients with alopecia areata: A single-centre real-world retrospective study. Acta Derm Venereol. Published online December 19, 2023. doi:10.2340/actadv.v103.12425