# Efficacy of Oral Tofacitinib in Alopecia Areata, Alopecia Totalis, and Alopecia Universalis

## TL;DR

This study shows that oral tofacitinib significantly improves hair regrowth in patients with alopecia areata and related conditions.

## Contribution

The study provides empirical evidence on the efficacy of oral tofacitinib for treating alopecia areata, alopecia totalis, and alopecia universalis.

## Key findings

- Patients showed an 88.9% mean regrowth rate after 24 weeks of tofacitinib treatment.
- Significant improvement in SALT scores was observed at 8, 12, and 24 weeks (p < 0.001).
- Most patients had alopecia areata, with a smaller number having alopecia universalis and alopecia totalis.

## Abstract

Objectives

Tofacitinib, an effective Janus kinase inhibitor (JAKi), has gained increasing interest in recent years for the management of refractory alopecia areata (AA). One of the most prevalent autoimmune diseases is AA, a kind of non-scarring alopecia. Therefore, the purpose of this study was to evaluate the efficacy of oral tofacitinib in treating AA, alopecia totalis (AT), and alopecia universalis (AU).

Methodology

This interventional study was conducted at Hamdard Medical University, Taj Medical Complex, using a non-probability consecutive sampling technique. The duration of the study was about six months. This study included 50 patients of both genders diagnosed with AA, AT, and AU, aged five years to 50 years, and who were fit for treatment with oral tofacitinib. Pediatric patients received 5 mg once daily, while adults received 5 mg twice daily. Treatment response was assessed at eight, 12, and 24 weeks using changes in the Severity of Alopecia Tool (SALT) score from baseline. A Chi-square test was used to compare SALT scores and percentage changes over the follow-up period.

Results

The study findings showed that the mean age of the patients was 25.6 ± 11.8 years. Of them, 23 (46.0%) were males, and 27 (54.0%) were females. The majority of the patients (39, 78.0%) had AA, with nine (18.0%) patients having AU, and two (4.0%) having AT. The mean (SD) pretreatment scalp hair loss was 62.48 ± 23.58 %, and the mean scalp involvement at 24-week follow-up was 10.5 ± 24.0%. The mean regrowth rate was 88.9 ± 24.5 %. Moreover, a statistically significant difference was observed between the changes in SALT score from baseline and the scores of SALT at eight, 12, and 24 weeks (p < 0.001).

Conclusion

This study concluded that administration of oral tofacitinib to AA patients had significantly improved hair growth. Additionally, it has been revealed to be a potentially efficacious therapy for the management of severe and refractory disease. However, our follow-up period was small, and some side effects, such as changes in lipid count and cardiovascular side effects, may take a longer time to develop; therefore, longer follow-up studies are needed to better evaluate the long-term safety of this drug in AA.