Alopecia areata is a common cause of hair loss that can, unfortunately, sometimes be difficult to treat. The more severe the symptoms, the longer the symptoms have been present and the earlier in life you first developed them can all influence how well you respond to therapy. All these factors have contributed to variations in success rates of different therapies and as a result, there is no one best option, or even a single approved option. On the bright side however there are many “off-label” treatments which have been in long-time use and are supported by clinical evidence.
Additionally there have been recent advances in basic science and our understanding of the disease which may mean the introduction of new medication, procedures and devices. Since alopecia areata is an autoimmune disease, medication targeted to the immune system is currently under investigation. For instance, recent case studies and clinical trials with immunomodulators have produced some promising data1–4. Examples include tofacitinib and ruxolitinib. Of the two, tofacitinib is believed to have a more specific effect on alopecia areata5–8. Both drugs are already approved for use in other autoimmune disease, tofacitinib for the treatment of rheumatoid arthritis9 and ruxolitinib for the treatment of myelofibrosis10. Side effects may include an increase in infection, anemia (a deficiency in blood cells), neutropenia (a deficiency in white blood cells), thrombocytopenia (a deficiency of blood platelets), headache and nausea8,11,12.
New research, a better understanding of the disease and new advancements in treatment options is always an exciting concept. Both tofacitinib and ruxolitinib are currently under investigation through clinical trials13,14 but will hopefully be available in the future. Talk to your doctor or hair restoration expert if you are interested in learning more about some of the emerging treatments for alopecia areata.
Article by: Dr. J.L. Carviel, PhD, Mediprobe Research Inc.
- Xing L, Dai Z, Jabbari A, Cerise JE, Higgins CA, Gong W, et al. Alopecia areata is driven by cytotoxic T lymphocytes and is reversed by JAK inhibition. Nat Med. 2014 Aug 17;20(9):1043–9.
- Pieri L, Guglielmelli P, Vannucchi AM. Ruxolitinib-induced reversal of alopecia universalis in a patient with essential thrombocythemia. Am J Hematol. 2015 Jan;90(1):82–3.
- Craiglow BG, King BA. Killing two birds with one stone: oral tofacitinib reverses alopecia universalis in a patient with plaque psoriasis. J Invest Dermatol. 2014 Dec;134(12):2988–90.
- Gupta A, Carviel J, Abramovits W. Efficacy of tofacitinib in treatment of alopecia universalis in two patients. J Eur Acad Dermatol Venereol. 2016;In press.
- Witthuhn BA, Silvennoinen O, Miura O, Lai KS, Cwik C, Liu ET, et al. Involvement of the Jak-3 Janus kinase in signalling by interleukins 2 and 4 in lymphoid and myeloid cells. Nature. 1994 Jul 14;370(6485):153–7.
- Riese RJ, Krishnaswami S, Kremer J. Inhibition of JAK kinases in patients with rheumatoid arthritis: scientific rationale and clinical outcomes. Best Pract Res Clin Rheumatol. 2010 Aug;24(4):513–26.
- Leonard WJ, O’Shea JJ. Jaks and STATs: biological implications. Annu Rev Immunol. 1998;16:293–322.
- Ortiz-Ibáñez K, Alsina MM, Muñoz-Santos C. Tofacitinib and other kinase inhibitors in the treatment of psoriasis. Actas Dermo-Sifiliográficas. 2013 May;104(4):304–10.
- Yamaoka K, Tanaka Y. Targeting the Janus kinases in rheumatoid arthritis: focus on tofacitinib. Expert Opin Pharmacother. 2014 Jan;15(1):103–13.
- Quintás-Cardama A, Vaddi K, Liu P, Manshouri T, Li J, Scherle PA, et al. Preclinical characterization of the selective JAK1/2 inhibitor INCB018424: therapeutic implications for the treatment of myeloproliferative neoplasms. Blood. 2010 Apr 15;115(15):3109–17.
- Adis Editorial. Tofacitinib. Drugs RD. 2010 Nov;10(4):271–84.
- Tefferi A, Pardanani A. Serious adverse events during ruxolitinib treatment discontinuation in patients with myelofibrosis. Mayo Clin Proc. 2011 Dec;86(12):1188–91.
- Mackay-Wiggan J. An Open-Label Pilot Study to Evaluate the Efficacy of Tofacitinib in Moderate to Severe Alopecia Areata, Totalis and Universalis [Internet]. 2014. Available from: http://clinicaltrials.gov/ct2/show/NCT02299290
- Mackay-Wiggan J. An open-label pilot study to evaluate the efficacy of ruxolitinib in moderate to severe alopecia areata. 2014.