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Commentary from Professor Andrew Messenger on new research

23rd June 2014

We were all interested to hear about a new research study that suggested a male with alopecia universalis had full hair regrowth after using a drug that is typically used in the USA for rheumatoid arthritis. We asked Alopecia UK advisory panel member, Professor Andrew Messenger, for his comments on the study.......

"Tofacitinib in Alopecia Universalis

In a letter published in the latest edition of the Journal of Investigative Dermatology the authors report treating a 25-year-old man with psoriasis with a drug called tofacitinib. The patient also had alopecia areata, starting at age 2 and becoming alopecia universalis by age 18. He noticed that his hair was regrowing after two months of treatment and by 8 months his hair had fully regrown except on his arms and legs.

Tofacitinib is a new drug that has been developed for the treatment of rheumatoid arthritis. It works by inhibiting an enzyme called Janus kinase (abbreviated to JAK), which is involved in activating immune cells that cause inflammation. Tofacitinib is also being tested as a treatment for other inflammatory diseases, such as psoriasis. The possibility that drugs that inhibit JAK might be effective in treating alopecia areata has been suggested from previous genetic studies and a clinical trial of another JAK inhibitor, ruxolitinib, is underway in the USA. Topical treatment with JAK inhibitors has also reversed hair loss in mice that develop a form of hair loss that closely resembles human alopecia areata.

The observation that we may finally have an effective treatment for alopecia areata is exciting but some caution is needed. There have been numerous reports of treatments that seem to work in one patient with alopecia areata but fail when tested in others. Proper clinical trials will be needed to confirm whether this is a true treatment response or just chance spontaneous recovery from alopecia universalis is pretty rare but it does happen. This may emerge from the American trial of ruxolitinib. There are two further considerations. First, JAK inhibitors suppress the immune system and can cause major side effects, especially serious infections, and regulatory authorities are unlikely to approve hair loss treatments that have significant physical side effects. Secondly, tofacitinib is expensive treatment costs about $25,000 per year and I suspect NHS funding would be hard to obtain for alopecia areata.

Nevertheless, if this observation is confirmed it will be a major advance towards a more effective treatment for alopecia areata. For the reasons mentioned we may not be able to use tofacitinib as an oral treatment but we can use the knowledge to develop cheaper and safer alternatives, such as a lotion or cream containing a JAK inhibitor. There is still some way to go but at last there are grounds for optimism.

PS Tofacitinib has been approved for the treatment of rheumatoid arthritis in the USA and in a few other countries but it has not yet been licensed in the EU for any indication."

To read more about the research study involving JAK inhibitor Tofacatinib, please see this web link.

To read more about Professor Andrew Messenger and his involvement with hair loss research here in the UK please see this web link.

Professor Andrew Messenger will also be speaking at our London 'Get Involved' Event in September.

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