Is Tofacitinib a "Cure" for Alopecia Areata?

A Closer Look at ‘Cure's vs ‘Treatments’ For Alopecia Areata

Tofacitinib (marketed under the name Xeljanz) is an exciting new treatment for alopecia areata. The drug is an inhibitor of a pathway inside immune cells known as the JAK pathway. For this reason, the drug is often referred to as a JAK inhibitor.

Tofacitinib is not a cure for alopecia areata but rather a treatment. What this means is that when tofacitinib is used, many people with alopecia areata will experience hair regrowth and when the drug is stopped most people will experience hair loss. Patients with advanced forms of alopecia areata who are using this medication to treat their hair loss require this drug long term. Although some patients may be able to lower the dose and rarely even stop the drug and still keep their hair - this is not the case with everyone. Many patients with alopecia areata require continued use of the medication if they wish to keep their hair. For this reason, we say that tofacitinib is a treatment and not a cure.

Is tofacitinib right for me?

Tofacitinib is not currently approved for treating alopecia areata. Although some patents will use it with a so called ‘off label’ use, these situations are taken on a case by case basis. Tofacitinib is not right for every patient. Generally speaking, the drug tofacitinib is reserved for more advanced cases of alopecia areata and for patients who have tried several treatments without success.

For patents with limited amount of hair loss from alopecia areata, such as those patients with a patch or two of hair loss, other treatments are likely to perform just as well as tofacitinib. This means that Tofacitinib is probably not the best choice for limited cases of alopecia areata. A patient with a patch of alopecia areata should consider steroid injections well ahead of considered oral tofacitinib. Even patients with new onset alopecia areata happening within the last 4-6 months are probably better off considering other treatments before tofacitinib. That of course is taken on a case by case basis.

But there is little doubt that that the most effective treatment to get hair growing back in cases of advanced long standing alopecia areata is tofacitinib. A patient who has had alopecia totalis for 2-3 years probably has the highest chance to respond to tofacitinib than to oral methotrexate or diphencyprone. Of course, it’s still possible that this patient will in fact grow hair back with oral methotrexate or diphencyprone so what we are talking about here is statistical odds. The odds are better in this scenario with oral tofacitinib than with oral methotrexate or topical diphencyprone. But with a price difference of $ 12,000 CAD per year for oral tofacitinib vs $ 500-1200 per year for methotrexate or diphencyprone, the right starting point for many people may in fact be the methotrexate or diphencyprone.

Conclusion

Tofacitinib is not a cure for alopecia areata despite the use of the term ‘cure’ in the popular press and media. Tofacitinib and the other JAK inhibitors like ruxolitinib and baricitinib are certainly the most effective treatments for patients with advanced alopecia areata (ie totalis and universalis) - but even with this information that does not always mean they are the starting point for patients with advanced alopecia due to considerations relating to cost, side effects and other issues.