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Tofacitinib plus oral minoxidil promotes hair regrowth in severe alopecia

Combination tofacitinib and oral minoxidil therapy in alopecia areata may be superior to tofacitinib alone, according to findings published in the Journal of the American Academy of Dermatology.

“Janus kinase inhibitors are emerging as an important therapy for severe alopecia areata and the possibility of increasing efficacy without increasing Janus kinase inhibitor dosage (and immunomodulation and cost of treatment) would be welcome,” Carlos G. Wambier, MD, PhD, of the department of dermatology at Yale University School of Medicine, and colleagues wrote.

Researchers reviewed cases of 12 adults with severe alopecia areata treated with combination tofacitinib and oral minoxidil for at least 6 months. Most patients (58%) were women.

All patients initially were prescribed Xeljanz (tofacitinib, Pfizer) 5 mg daily. Oral minoxidil administration began at the same time at doses of 2.5 mg daily in women and 2.5 mg twice daily in men. Women received a smaller dose to minimize hypertrichosis.

Researchers assessed scalp hair loss using the Severity of Alopecia Tool (SALT), which was 99.5% at median baseline.

Eight patients achieved SALT₇₅ ( 75% scalp hair regrowth) and four patients achieved SALT_11-74 (11%-74% scalp hair regrowth). Among the eight patients who achieved SALT₇₅, seven achieved hair regrowth with tofacitinib 5 mg twice daily and the other patient on 10 mg twice daily, due to a poor response with 5 mg twice daily over 4 to 6 months, according to researchers.

The median final SALT score was 6.5%.

“Notably, one patient who had not achieved any hair regrowth 1 year prior with tofacitinib 11 mg extended release once daily for 3 months, experienced substantial hair regrowth over the first 3 months of combination therapy with the equivalent dose of tofacitinib, 5 mg twice daily,” Wambier and colleagues wrote.

Study limitations include retrospective study design and the small sample size. – by Abigail Sutton

Disclosures: Wambier reports he is an investigator for Concert Pharmaceuticals, Eli Lilly and Co. and Pfizer. Please see the study for all other authors’ relevant financial disclosures.