Tofacitinib in the Recalcitrant Cases of Alopecia Areata: A Pilot Study

Background: Alopecia areata (AA) is an autoimmune disorder where the immune system attacks hair follicles, causing non-scarring hair loss. It is driven by cytotoxic T lymphocytes and the JAK/STAT signaling pathway, leading to inflammation. JAK inhibitors, including tofacitinib, showed promising results in treating AA by reducing interferon and preventing progression. Aims: To know the efficacy of oral Tofacitinib in the recalcitrant cases of alopecia areata, to know safety profile and side effects of oral Tofacitinib during the study period. Materials and Methods: The study was conducted over a period of 6 months from Sept 2023 to May 2024, in recalcitrant cases of alopecia areata age 10-50 years meeting the inclusion and exclusion criteria attending OPD in tertiary care center . 20 patients were considered. The SALT (Severity of Alopecia Areata) score was utilized to assess disease progression and evaluate the effectiveness of tofacitinib. Results: Most common pattern observed was Patchy alopecia areata. The age group ranged from 10 to 50 years and most common age group was <19 years. A significant decrease in salt score was observed in majority of patients between 1st month and at 6th month. The regrowth of hair was observed in all patients except with 1 patient who lost to follow up. Side effects were seen only in 3 patients. After 19 patients were treated with Tab.Tofacitinib 5mg BD for a duration of 6 months, it was found that average percentage SALT score improved by 27% (P value < 0.005). Limitations: Small sample size and short duration of study. Conclusion: Oral tofacitinib was most effective in treating alopecia areata with 5mg BD dose with minimal side effects but requires proper lab monitoring to ensure patient safety.