Treating Alopecia Areata with Arthritis Drugs: The Excitement of Tofacitinib

By Dr. Jeff Donovan, Canadian Hair Loss Foundation

 

Tofacitinib (Xeljanz) for Alopecia Areata

 

A recent scientific publication in the Journal of the Investigative Dermatology has set off a wave of excitement about an experimental treatment for alopecia areata. In that study, a 25 year old man with both psoriasis and alopecia areata was treated with the arthritis drug tofacitinib (also called Xeljanz). Within 8 months of treatment the man had grown hair.

This is an exciting study. Certainly, every new piece of information pushes us that much closer to understanding the best treatment for alopecia areata.  

 

10 things to know about Tofacitinib

  1. Tofacitinib (also called “Xeljanz”) is a relatively new drug approved for treating rheumatoid arthritis. Tofacitinib is not formally approved for alopecia areata - this study is just 'experimental' at this stage 

  2. The drug works by blocking an enzyme called the Janus kinase (type 1/3).  

  3. Tofacitinib is an immunosuppressant medication.   

  4. Tofacitinib is a treatment, not a cure for alopecia areata -  In order for the man in this study to keep his hair, he will need to remain on the medication. 

  5. Tofacitinib has potential side effects and should only be prescribed by a physician who is very knowledgeable about the drug and should only be used by patients who are very knowledgeable about the potential side effects.

  6. As an immunosuppressant, the drug can increase the risk of infection. In fact, serious infections occur in approximately 2 % of patients.

  7. The long term risk for cancer also needs to be considered in patients taking Tofacitinib.

  8. The drug can reduce heart rate by approximately 5 beats per minutes and sometimes can’t be used in patients with heart problems.

  9. Frequent blood monitoring is needed while on the drug as the drug can irritate the liver.

  10. Tofacitinib can sometimes lower blood counts and sometimes raise cholesterol levels.

 

Summary 

The drug tofacitinib may be helpful someday for patients with alopecia areata, alopecia totalis and alopecia universalis, but more studies are needed. With results from one patient, we can't conclude much yet.  All physicians prescribing the drug and all patients who wish to consider the drug need to be aware of the short term and long term risks. 

 

 

Reference

1. Craiglow BG, King BA. Killing Two Birds with One Stone: Oral Tofacitinib Reverses Alopecia Universalis in a Patient with Plaque Psoriasis. Journal of Investigative Dermatology 2014 Jun 18.

 



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