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JAK inhibitors in Trichology

‘Janus kinase’ (JAK) inhibitors are a group of pharmaceutical drug – principally Ruxolitinib/Tofacitinib (1) – which clinical trials have shown to be ‘promising’ in the medical treatment of autoimmune (scalp) hair loss, androgenic alopecia and other dermatological conditions (2).

Early studies suggest JAK inhibitors are ‘relatively safe’ (Mackay-Wiggan: 2017); seemingly limited to chest infection (URTI), headaches and liver enzyme changes (3). Other potential side effects include anaemia, fatigue, thrombocytopenia (4), breathlessness, hypertension (a known side effect of Tofacitinib), Gut disturbance and weight gain.

As a class of potent immunosuppressive drugs, JAK inhibitors may pose potential but significant side effect risks to those with concomitant health conditions (NAAF: 2016), so each person should be medically assessed as to their appropriateness for this drug.

Small pilot studies have been undertaken at both Columbia and Stanford/Yale universities (5) trialing JAK inhibitor therapy for moderate – severe Alopecia areata. Three quarters of the Columbia University study achieved 50% or greater improvement throughout the trial.

One third of subjects in the three month Stanford/Yale trial achieved and maintained 50% or greater improvement in their pilot study.

Disappointingly these areata remissions did not sustain; 50% of subjects experienced significant hair shedding from 3 weeks to 3 months following Ruxolitinib’s withdrawal. A similar percentage of subjects in the Stanford/Yale trial regressed once Tofacitinib therapy discontinued.

Studies continue to evaluate JAK inhibitors in the treatment of scalp alopecia, but we should be mindful that these drugs – like others before them – are NOT curative but immunological ‘over-riders’. And because Alopecia areata is often an expression of internal disturbance, deficiency or underlying illness – their use should always only be considered after thorough clinical assessment and pathology investigation.

 

  1. Tofacitinib is currently FDA-approved in the treatment of Rheumatoid arthritis. Tofacitinib is marketed by the Pfizer pharmaceutical company under the name Xeljanz. Ruxolitinib goes under the brand name of Jakafi; a product of the Incyte Corporation.
  2. Severe Alopecia areata, Eczema + Vitiligo.
  3. Mildly elevated liver Transaminase levels.
  4. Low blood platelets (platelets are crucial for the clotting of blood).
  5. One uncontrolled study of 12 patients at Columbia (trialing Ruxolitinib) & 66 patients at Stanford/Yale trialing Tofacitinib.

Copyright Anthony Pearce 2018