Systemic Tofacitinib in Alopecia Areata: A Single Center Retrospective Descriptive Cohort Study

Export Objective: Alopecia areata (AA) is an autoimmune disease that is characterized by patchy, non-scarring hair loss. In the past few years, there has been increasing interest, with many reports, about the successful use of tofacitinib, a Janus kinase inhibitor as an off-label treatment for AA with a good safety profile. Despite the rate of a high prevalence of AA in our area, there is a lack of studies in our geographical region about the outcomes of tofacitinib. This study aims to share our single-center experience regarding the uses and outcomes of systemic tofacitinib in the treatment of alopecia areata since its inclusion in the formulary from 2014 to 2021. Methods: This is a retrospective descriptive cohort study based on electronic records of patients with non-scarring, clinically active alopecia areata who were treated with oral tofacitinib in our medical center. Efficacy was defined as improvement in the Severity of Alopecia Tool (SALT) score from baseline; non-responders with “0” change from baseline were minimal (1–29%), moderate (30–59%), and significant (60% and above). Efficacy was assessed using a physical examination upon follow-up visits, while safety was assessed with frequent lab monitoring along with a physical examination. Results: A total of 45 cases were included in this study. The mean duration of therapy was 30 months (range: 12–72 months), with an average dose of 12.5mg daily (range: 5–20mg). Significant to moderate improvement, with regrowth of hair as reflected in SALT efficacy from the baseline, was achieved in 35 cases (78%), while 10 cases showed minimal to no improvement (22%). Patients with a disease duration of less than 10 years and pediatric cases younger than 16 years old responded better to treatment. Treatment discontinuation resulted in hair loss in a period of 1–4 weeks and regrowth of hair without loss of efficacy upon resuming tofacitinib treatment. Dyslipidemia was the most common associated side effect, which was mild and did not necessitate stopping the medication. Conclusions: Our study demonstrated that tofacitinib is an effective and well-tolerated treatment for alopecia areata in both the pediatric and adult age groups, even in patients with severe recalcitrant disease course, provided proper patient supervision, and clinical and laboratory follow-up.