Speaker discusses use of JAK inhibitors in alopecia

A speaker at South Beach Symposium Medical Dermatology Summit discussed the JAK inhibitors that are currently on the market and their applications in treating alopecia areata.

Antonella Tosti, MD, said that JAK inhibitors “are probably the future of treatment for alopecia areata.”

Of the three main JAK inhibitors used for alopecia areata — ruxolitinib, baricitinib and tofacitinib — tofacitinib “has been most studied,” Tosti said. The standard dose of tofacitinib is 5 mg twice daily.

Patients usually regrow hair about 3 months after beginning treatment, and even though some patients may take longer, they should “persist and continue the treatment,” she said.

About 70% of patients respond to tofacitinib, although it is typically less effective in long-standing alopecia totalis or alopecia universalis. However, the oral formulation is more effective than the topical formulation, Tosti said.

Large clinical trials for ruxolitinib and baricitinib are ongoing, according to Tosti. In the literature cited during the presentation, ruxolitinib doses were 10 mg twice daily and 10 mg every other day. She also said “usually ruxolitinib causes visible regrowth earlier than tofacitinib.”

There is not yet data on long-term side effects, but patients commonly experience upper respiratory infections, headache and weight gain. Given the potential danger of upper respiratory infections during the era of COVID-19, Tosti has advised her patients to discontinue treatment if they develop COVID-19 symptoms. Other side effects, such as severe infection, have been reported among patients taking a JAK inhibitor for another indication.

Tosti said there are several JAK inhibitor compounds in the phase 2 or 3 stage of development.