doi: 10.1001/jamadermatol.2017.0001Īuthor Contributions: Drs Ibrahim and Bergfeld had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. 5Īccepted for Publication: December 29, 2016.Ĭorresponding Author: Omer Ibrahim, MD, Department of Dermatology, Cleveland Clinic Foundation, 9500 Euclid Ave, A61, Cleveland, OH 44195 ( Online: March 29, 2017. 3 Dosages higher than 10 mg twice a day may be associated with higher risk for serious infections and malignant neoplasms, which have been reported at baseline dosages of 5 mg twice daily. In retrospect, the daily doses could have been lower and increased more gradually yet still achieved similar results given that patient response seemed to be both dose and time dependent. ![]() Limitations of this study included the absence of a control group, which prevented the comparison of tofacitinib with a placebo, and the small sample size, which precluded subgroup analyses. In addition, our results demonstrate lack of durability of effect after the discontinuation of therapy, a finding similar to that in other studies. 3 This outcome may be related to our higher doses, longer duration of therapy, and patients’ shorter duration of current disease episode. Although small, our cohort achieved greater median improvement in SALT scores than reported in previously published studies (50.5% vs 21%). 1 Our results indicate that tofacitinib is efficacious in the treatment of AA. Janus kinase inhibitors have been shown to attenuate the inflammatory cascade associated with AA. Of note, 2 patients demonstrated lipid and liver abnormalities that were resolved when the dose was reduced ( Table). The remaining 11 patients continued treatment. Two patients stopped therapy after 3 months because of loss of insurance and within 2 weeks experienced a shed that led back to baseline levels. One patient developed a morbilliform eruption and peripheral edema that led to medication withdrawal. Response time-time from initiation of treatment to any sign of hair regrowth-ranged from 1 to 9 months, with a mean (SD) of 4.2 (2.6) months. Seven patients (53.8%) achieved a regrowth of at least 50% ( Figure, B). Regrowth rate-(final SALT score − initial SALT score)/(initial SALT score) × 100-ranged from 2% to 90%, with a mean (SD) of 44.3% (31.9) and a median (range) of 50.5% (90 ) ( Table). The mean (SD) pretreatment scalp hair loss was 93% (11.5), with 2 patients having alopecia totalis ( Figure, A) and 7 patients having alopecia universalis. ![]() We identified 13 patients with AA who were or are being treated with tofacitinib. Shared Decision Making and Communication. ![]()
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