Tofacitinib: A promise for treating alopecia areata in teens
Before I begin, I would like to say Happy 17th Birthday today to JN! It is for you and your lifelong challenge with alopecia areata and now alopecia universalis that I write this. I encourage you to remain invested in learning and science.
What is tofacitinib?
Tofacinitib is the generic name of a type of drug called a Janus Kinase (JAK) inhibitor. This oral medication alters cell signaling pathways involved in immune processes related to blood cell and inflammatory diseases. Alopecia areata is an autoimmune hair loss condition that may benefit from treatment with tofacitinib. It is driven by abnormal white blood cells called cytotoxic T cells and suppressing these cells can improve the disease.
A small study in teens
Yale School of Medicine studied tofacitinib in 13 teenagers between the ages of 12 and 17 with alopecia areata (median age 15) from July 2014 to May 2016. In an effort to study its efficacy in adolescents with alopecia areata, all subjects received tofacitinib 5 mg daily during that time. One patient had complete regrowth of hair, nine had significant growth, and the remaining three had very little hair regrowth. Tofacitinib was well tolerated by everyone with only mild side effects. Adverse side effects included headaches, respiratory infections, and mild elevation of liver enzymes. Since tofacitinib suppresses the immune system, there is concern about increased cancer risks patients taking this medication over time. Compared to other studies done at Columbia University and Cleveland Clinic, tofacitinib appeared to be more effective in this small group of young of patients. It is unclear what led to higher response rates in the younger cohort compared to older patient cohort studies. Also, it is unclear how to determine who will be a responder to treatment, with a focus on genetics likely playing a role in determining response rates.
Where is tofacitinib now?
Besides alopecia areata, we have learned that JAK inhibitors may also be helpful in other autoimmune or autoinflammatory diseases such as vitiligo, atopic dermatitis, psoriasis, and lupus. Rare diseases like graft versus host disease and cutaneous T cell lymphoma may also be treatment targets for JAK inhibitors. More studies are needed to fully understand the impact on these conditions in addition to the long-term risks associated with JAK inhibitor use. Early onset of alopecia areata, especially in adolescents, usually confers a worse prognosis or disease course. Therefore, tofacitinib and medications like it that demonstrated great efficacy in young patients may transform their disease course and also give us invaluable insight into the long-term use of these medications.
Craiglow BG, et al. Xeljanz shows promise as treatment for alopecia areata in adolescents. J Am Acad Dermatol. 2016;doi:10.1016/j.jaad.2016.09.006.
Shreberk-Hassidim R, Ramot Y, Zlotogorski A. Janus kinase inhibitors in dermatology: A systematic review. J Am Acad Dermatol. 2017 Feb 3.