Arthritis Drug Spurs Hair Growth
Yale researchers treat alopecia with tofacitinib
A man with almost no hair on his body has grown a full head of it after a novel treatment by physicians at Yale University.
There is currently no cure or long-term treatment for alopecia universalis, the disease that left the 25-year-old patient bare of hair. This is the first reported case of a successful targeted treatment for the rare, highly visible disease.
The patient has also grown eyebrows and eyelashes, as well as facial, armpit, and other hair, which he lacked at the time he sought help.
The patient had been diagnosed with both alopecia universalis, a disease that results in the loss of all body hair, and plaque psoriasis, a condition characterized by scaly red areas of skin. The only hair on his body was within the psoriasis plaques on his head. He was referred to Yale Dermatology for treatment of the psoriasis. The alopecia universalis had never been treated.
Lead investigator Dr. Brett A. King believed it might be possible to address both diseases simultaneously using tofacitinib citrate (Xeljanz, Pfizer), an FDA-approved therapy for rheumatoid arthritis. The drug had been used successfully for treating psoriasis in humans. It had also reversed alopecia areata, a less extreme form of alopecia, in mice.
“There are no good options for long-term treatment of alopecia universalis,” King said. “The best available science suggested this might work, and it has.”
After 2 months of treatment with tofacitinib 10 mg daily, the patient’s psoriasis showed some improvement, and the man had grown scalp and facial hair — the first hair he’d grown there in 7 years. After 3 more months of therapy at 15 mg daily, the patient had completely regrown scalp hair and also had clearly visible eyebrows, eyelashes, and facial hair, as well as armpit and other hair, the investigators said.
“By eight months there was full regrowth of hair,” said co-author Dr. Brittany G. Craiglow. “The patient has reported feeling no side effects, and we’ve seen no lab test abnormalities, either.”
Tofacitinib appears to spur hair regrowth in a patient with alopecia universalis by turning off the immune system attack on hair follicles that is prompted by the disease, King said.
She has submitted a proposal for a clinical trial involving a cream form of tofacitinib as a treatment for alopecia areata.
Xeljanz (tofacitinib citrate) is a Janus kinase (JAK) inhibitor indicated for the treatment of adult patients with moderately to severely active rheumatoid arthritis who have had an inadequate response to or are intolerant of methotrexate.
JAKs are intracellular enzymes that transmit signals arising from cytokine or growth factor-receptor interactions on the cellular membrane to influence the cellular processes of hematopoiesis and immune cell function. Within the signaling pathway, JAKs phosphorylate and activate signal transducers and activators of transcription (STATs), which modulate intracellular activity, including gene expression.
Tofacitinib modulates the signaling pathway at the point of JAKs, preventing the phosphorylation and activation of STATs. JAK enzymes transmit cytokine signaling through pairing of JAKs (e.g., JAK1/JAK2, JAK1/JAK3, and JAK1/TyK2). However, the relevance of specific JAK combinations to the therapeutic effectiveness of tofacitinib is not known.