Zhang Wenxin, Li Xiangqian, Chen Baifu, Zhang Jianzhong, Torres-Culala Kara Melissa T, Zhou Cheng
Department of Dermatology, Peking University People's Hospital, Beijing, China.
Department of Dermatology, Jose R. Reyes Memorial Medical Center, Manila, Philippines.
Front Med (Lausanne). 2022 Jun 21;9:891434. doi: 10.3389/fmed.2022.891434. eCollection 2022.
Alopecia areata (AA) is an autoimmune hair loss mediated by CD8 + T cells. Treatment for moderate-to-severe AA is still challenging. Janus kinase inhibitors, such as tofacitinib, have been recently investigated as a promising treatment option for AA. Evidence on the combination use of oral tofacitinib and systemic corticosteroids (SCs) for AA is still lacking.
To compare the efficacy and safety of monotherapy of oral tofacitinib and SCs, as well as their combination in patients with moderate-to-severe AA.
Patients with moderate-to-severe AA, who have been treated with at least 3 months of monotherapy of tofacitinib or SCs, or in their combination, were included in this study. The efficacy and adverse events of these treatments were retrospectively analyzed.
Sixty-one patients with moderate-to-severe AA were included in this study. There were 12 (66.7%) of 18 patients in the SCs group, 12 (60.0%) of 20 patients in the tofacitinib group, and 18 (78.3%) of 23 patients achieved SALT, with no significant difference among the three groups. The ratio of patients who achieved SALT was significantly higher in patients with a short duration of current hair loss episode (≤2 years) than in those with a duration of current hair loss episode (>2 years) in all the three groups. There were 66.7% patients in the SCs group, 35.0% patients in the tofacitinib group, and 56.5% patients in the combined group that showed adverse effects.
Tofacitinib was an effective treatment for patients with moderate-to-severe AA, and it was more tolerated than SCs. A combination of tofacitinib and SCs may have higher efficacy than SCs alone. Efficacy significantly decreased in patients with a current episode of disease for more than 2 years.
斑秃（AA）是一种由CD8 + T细胞介导的自身免疫性脱发。中重度斑秃的治疗仍然具有挑战性。近年来，诸如托法替布等Janus激酶抑制剂已被研究作为斑秃的一种有前景的治疗选择。关于口服托法替布与系统性糖皮质激素（SCs）联合用于斑秃治疗的证据仍然缺乏。
比较口服托法替布和系统性糖皮质激素单药治疗以及它们联合治疗中重度斑秃患者的疗效和安全性。
本研究纳入了接受过至少3个月托法替布或系统性糖皮质激素单药治疗或联合治疗的中重度斑秃患者。对这些治疗的疗效和不良事件进行回顾性分析。
本研究纳入了61例中重度斑秃患者。系统性糖皮质激素组18例患者中有12例（66.7%）、托法替布组20例患者中有12例（60.0%）、联合治疗组23例患者中有18例（78.3%）达到了静止期脱发（SALT），三组之间无显著差异。在所有三组中，当前脱发发作持续时间较短（≤2年）的患者达到SALT的比例显著高于当前脱发发作持续时间较长（>2年）的患者。系统性糖皮质激素组有66.7%的患者、托法替布组有35.0%的患者、联合治疗组有56.5%的患者出现了不良反应。
托法替布是治疗中重度斑秃患者的有效药物，且其耐受性优于系统性糖皮质激素。托法替布与系统性糖皮质激素联合使用可能比单独使用系统性糖皮质激素具有更高的疗效。疾病当前发作超过2年的患者疗效显著降低。
