Real‐World Efficacy and Safety of Tofacitinib for Patients With Alopecia Areata: A Retrospective Multi‐Center Cohort Study

The approval of baricitinib and ritlecitinib for alopecia areata (AA) marks the beginning of the Janus kinase (JAK) inhibitor era in AA treatment. Tofacitinib, a first-generation JAK1/3 inhibitor, has theoretical potential to treat AA; however, real-world evidence, particularly on comparative outcomes across patient subgroups and patient-reported outcomes, remains limited. In this multi-center, retrospective cohort study, we evaluated the efficacy and safety of tofacitinib in refractory AA using objective clinical assessments, including SALT scores and four-point eyebrow and eyelash scales, alongside patient-reported outcomes, namely DLQI/CDLQI and VAS scores. After 12 weeks of treatment, tofacitinib substantially reduced SALT scores and promoted eyebrow and eyelash regrowth, accompanied by meaningful improvements in patient-reported outcomes. Efficacy was greater in patients with severe AA than in those with non-severe AA and was consistent across pediatric and adult populations. Some patients experienced transient disease worsening, which was manageable without treatment escalation. Despite the study's small sample size and retrospective design, tofacitinib demonstrated significant efficacy in both objective and patient-reported measures, supporting its use as a viable therapeutic option for severe AA and underscoring the value of incorporating patient-reported outcomes in real-world studies.