Effectiveness of Tofacitinib in Pre-adolescent Alopecia Areata: A Retrospective Case Series and Literature Review
DOI:
https://doi.org/10.2340/actadv.v103.13418Keywords:
Alopecia areata, Tofacitinib, Pre-adolescent, pediatric dermatology, treatmentAbstract
Alopecia areata (AA) is a common cause of hair loss in children. Despite numerous therapeutic options for paediatric AA, none have been found to be both effective and safe. Recent studies have demonstrated the efficacy and safety of the Janus kinase (JAK) inhibitor tofacitinib in adult patients with AA, whereas data on paediatric patients with AA in real-world practice are limited. This was a single-centre, retrospective study that included 11 pre-adolescent patients with AA treated with tofacitinib between December 2021 and September 2022. Clinical characteristics of patients, clinical response and adverse events were evaluated. Overall, 82% (9/11) of patients experienced hair regrowth and 64% (7/11) of patients experienced over 50% improvement in their Severity of Alopecia Tool (SALT) scores. Adverse events were mild. In the literature, tofacitinib has been used to treat AA in 31 children ≤12 years of age who failed to respond to prior treatments. Eighty-seven percent (27/31) of these patients showed significant responses based on changes in their SALT scores. This case series demonstrates that oral tofacitinib is an effective and safe treatment option for paediatric AA, particularly for children who have failed to respond to traditional treatments or are not suitable for such treatments.
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References
Gilhar A, Etzioni A, Paus R. Alopecia areata. New Engl J Med 2012; 366: 1515-1525.
https://doi.org/10.1056/NEJMra1103442 DOI: https://doi.org/10.1056/NEJMra1103442
Kyriakis KP, Paltatzidou K, Kosma E, Sofouri E, Tadros A, Rachioti E. Alopecia areata prevalence by gender and age. J Eur Acad Dermatol 2009; 23: 572-573.
https://doi.org/10.1111/j.1468-3083.2008.02956.x DOI: https://doi.org/10.1111/j.1468-3083.2008.02956.x
Cranwell WC, Lai VW, Photiou L, Meah N, Wall D, Rathnayake D, et al. Treatment of alopecia areata: an Australian expert consensus statement. Austral J Dermatol 2019; 60: 163-170.
https://doi.org/10.1111/ajd.12941 DOI: https://doi.org/10.1111/ajd.12941
Lai V, Sinclair R. Utility of azathioprine, methotrexate and cyclosporine as steroid-sparing agents in chronic alopecia areata: a retrospective study of continuation rates in 138 patients. J Eur Acad Dermatol 2020; 34: 2606-2612.
https://doi.org/10.1111/jdv.16858 DOI: https://doi.org/10.1111/jdv.16858
Liu LY, King BA, Craiglow BG. Health-related quality of life (HRQoL) among patients with alopecia areata (AA): a systematic review. J Am Acad Dermatol 2016; 75: 806-812.
https://doi.org/10.1016/j.jaad.2016.04.035 DOI: https://doi.org/10.1016/j.jaad.2016.04.035
Jerjen R, Meah N, Trindade DCL, Wall D, Eisman S, Sinclair R. Treatment of alopecia areata in pre-adolescent children with oral tofacitinib: a retrospective study. Pediatr Dermatol 2021; 38: 103-108.
https://doi.org/10.1111/pde.14422 DOI: https://doi.org/10.1111/pde.14422
Barton VR, Toussi A, Awasthi S, Kiuru M. Treatment of pediatric alopecia areata: a systematic review. J Am Acad Dermatol 2022; 86: 1318-1334.
https://doi.org/10.1016/j.jaad.2021.04.077 DOI: https://doi.org/10.1016/j.jaad.2021.04.077
Afford R, Leung A, Lam JM. Pediatric alopecia areata. Curr Pediatr Rev 2021; 17: 45-54.
https://doi.org/10.2174/1573396316666200430084825 DOI: https://doi.org/10.2174/1573396316666200430084825
Lensing M, Jabbari A. An overview of JAK/STAT pathways and JAK inhibition in alopecia areata. Front Immunol 2022; 13: 955035.
https://doi.org/10.3389/fimmu.2022.955035 DOI: https://doi.org/10.3389/fimmu.2022.955035
Liu LY, Craiglow BG, Dai F, King BA. Tofacitinib for the treatment of severe alopecia areata and variants: a study of 90 patients. J Am Acad Dermatol 2017; 76: 22-28.
https://doi.org/10.1016/j.jaad.2016.09.007 DOI: https://doi.org/10.1016/j.jaad.2016.09.007
Park HS, Kim MW, Lee JS, Yoon HS, Huh CH, Kwon O, et al. Oral tofacitinib monotherapy in Korean patients with refractory moderate-to-severe alopecia areata: a case series. J Am Acad Dermatol 2017; 77: 978-980.
https://doi.org/10.1016/j.jaad.2017.06.027 DOI: https://doi.org/10.1016/j.jaad.2017.06.027
Brown L, Skopit S. An excellent response to tofacitinib in a pediatric alopecia patient: a case report and review. J Drugs Dermatol 2018; 17: 914-917.
Castelo-Soccio L. Experience with oral tofacitinib in 8 adolescent patients with alopecia universalis. J Am Acad Dermatol 2017; 76: 754-755.
https://doi.org/10.1016/j.jaad.2016.11.038 DOI: https://doi.org/10.1016/j.jaad.2016.11.038
Craiglow BG, King BA. Tofacitinib for the treatment of alopecia areata in preadolescent children. J Am Acad Dermatol 2019; 80: 568-570.
https://doi.org/10.1016/j.jaad.2018.08.041 DOI: https://doi.org/10.1016/j.jaad.2018.08.041
Dai YX, Chen CC. Tofacitinib therapy for children with severe alopecia areata. J Am Acad Dermatol 2019; 80: 1164-1166.
https://doi.org/10.1016/j.jaad.2018.12.041 DOI: https://doi.org/10.1016/j.jaad.2018.12.041
Geng SL, Gong T, Ji C, Su HH. Oral tofacitinib for successful treatment of refractory alopecia areata in preschool children. J Eur Acad Dermatol 2022; 36: e1055-e1057.
https://doi.org/10.1111/jdv.18447 DOI: https://doi.org/10.1111/jdv.18447
Kibbie J, Kines K, Norris D, Dunnick CA. Oral tofacitinib for the treatment of alopecia areata in pediatric patients. Pediatr Dermatol 2022; 39: 31-34.
https://doi.org/10.1111/pde.14855 DOI: https://doi.org/10.1111/pde.14855
Youssef S, Bordone LA. Clinical response to oral tofacitinib in pediatric patients with alopecia areata. JAAD Case Rep 2023; 31: 83-88.
https://doi.org/10.1016/j.jdcr.2022.08.024 DOI: https://doi.org/10.1016/j.jdcr.2022.08.024
Nash P, Kerschbaumer A, Dorner T, Dougados M, Fleischmann RM, Geissler K, et al. Points to consider for the treatment of immune-mediated inflammatory diseases with Janus kinase inhibitors: a consensus statement. Ann Rheum Dis 2021; 80: 71-87.
https://doi.org/10.1136/annrheumdis-2020-218398 DOI: https://doi.org/10.1136/annrheumdis-2020-218398
Guo L, Feng S, Sun B, Jiang X, Liu Y. Benefit and risk profile of tofacitinib for the treatment of alopecia areata: a systemic review and meta-analysis. J Eur Acad Dermatol 2020; 34: 192-201.
https://doi.org/10.1111/jdv.15937 DOI: https://doi.org/10.1111/jdv.15937
Bernardis E, Nukpezah J, Li P, Christensen T, Castelo-Soccio L. Pediatric severity of alopecia tool. Pediatr Dermatol 2018; 35: e68-e69.
https://doi.org/10.1111/pde.13327 DOI: https://doi.org/10.1111/pde.13327
Hogan S, Wang S, Ibrahim O, Piliang M, Bergfeld W. Long-term treatment with tofacitinib in severe alopecia areata: an update. J Clin Aesthet Dermatol 2019; 12: 12-14.
Ruperto N, Brunner HI, Synoverska O, Ting TV, Mendoza CA, Spindler A, et al. Tofacitinib in juvenile idiopathic arthritis: a double-blind, placebo-controlled, withdrawal phase 3 randomised trial. Lancet 2021; 398: 1984-1996.
https://doi.org/10.1016/S0140-6736(21)01255-1 DOI: https://doi.org/10.1016/S0140-6736(21)01255-1
Freyschmidt-Paul P, McElwee KJ, Happle R, Kissling S, Wenzel E, Sundberg JP, et al. Interleukin-10-deficient mice are less susceptible to the induction of alopecia areata. J Invest Dermatol 2002; 119: 980-982.
https://doi.org/10.1046/j.1523-1747.2002.00230.x DOI: https://doi.org/10.1046/j.1523-1747.2002.00230.x
McElwee KJ, Hoffmann R, Freyschmidt-Paul P, Wenzel E, Kissling S, Sundberg JP, et al. Resistance to alopecia areata in C3H/HeJ mice is associated with increased expression of regulatory cytokines and a failure to recruit CD4+ and CD8+ cells. J Invest Dermatol 2002; 119: 1426-1433.
https://doi.org/10.1046/j.1523-1747.2002.19620.x DOI: https://doi.org/10.1046/j.1523-1747.2002.19620.x
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