Department of Dermatology, Seoul National University College of Medicine, Korea.
Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea.
Indian J Dermatol Venereol Leprol. 2021 Sep-Oct;87(5):621-627. doi: 10.25259/IJDVL_975_19.
Tofacitinib and ruxolitinib have been used off-label to treat alopecia areata. Although a number of case reports and small studies have been published, there are no comprehensive reviews examining the outcomes of using tofacitinib and ruxolitinib for the treatment of alopecia areata.
The aim of the study was to examine the outcome of patients with alopecia areata treated with oral tofacitinib or ruxolitinib in previously published studies.
A search of MEDLINE, Embase and Cochrane library was conducted. A systematic review and meta-analysis were performed focusing on the Severity of Alopecia Tool 50 achievement rate, the frequency of adverse events and recurrence after discontinuation of treatment.
A total of 1244 studies were identified of which only 12 studies met the inclusion criteria. Of the 346 patients in these 12 studies, 288 had received oral tofacitinib and 58 had received oral ruxolitinib. The overall Severity of Alopecia Tool50 achievement rate was 66% (95% confidence interval, 54%-76%). Subgroup analysis revealed that drug choice, mean age, sex ratio and alopecia areata subtype ratio did not significantly affect the treatment response. Infections and laboratory abnormalities were the most common adverse events (98 and 65 cases of 319 patients, respectively). Patients treated for more than six months had a greater frequency of laboratory abnormalities as compared to those treated for shorter durations (24% vs. 7%; P = 0.04). Recurrence of alopecia areata was observed within three months after discontinuation of treatment in the majority (74%) of patients.
This analysis was limited by the small number of observational studies available for review, the heterogeneity of patient characteristics and the lack of long-term data.
Both oral tofacitinib and ruxolitinib are effective and well tolerated in the treatment of alopecia areata. Clinicians should be aware of the expected efficacy, adverse events and high recurrence rate of oral JAK inhibitors for alopecia areata to effectively counsel these patients before starting therapy.
托法替尼和鲁索替尼已被用于治疗斑秃的适应证外。尽管已经发表了许多病例报告和小型研究，但没有全面的综述来检查使用托法替尼和鲁索替尼治疗斑秃的结果。
本研究旨在检查以前发表的研究中使用口服托法替尼或鲁索替尼治疗斑秃患者的结果。
对 MEDLINE、Embase 和 Cochrane 图书馆进行了检索。进行了系统评价和荟萃分析，重点关注严重程度脱发工具 50 （Severity of Alopecia Tool 50，SALT50）达标率、不良事件发生频率以及停药后复发情况。
共确定了 1244 项研究，其中只有 12 项研究符合纳入标准。在这 12 项研究的 346 名患者中，288 名接受了口服托法替尼治疗，58 名接受了口服鲁索替尼治疗。总体 SALT50 达标率为 66%（95%置信区间，54%-76%）。亚组分析显示，药物选择、平均年龄、性别比例和斑秃亚型比例对治疗反应无显著影响。感染和实验室异常是最常见的不良事件（319 名患者中有 98 例和 65 例分别发生感染和实验室异常）。治疗时间超过 6 个月的患者发生实验室异常的频率高于治疗时间较短的患者（24%比 7%；P = 0.04）。大多数（74%）患者在停药后 3 个月内复发。
本分析受到可用于审查的观察性研究数量较少、患者特征的异质性以及缺乏长期数据的限制。
口服托法替尼和鲁索替尼治疗斑秃均有效且耐受良好。临床医生应了解口服 JAK 抑制剂治疗斑秃的预期疗效、不良事件和高复发率，以便在开始治疗前有效为这些患者提供咨询。
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