Effectiveness of Tofacitinib in Pre-adolescent Alopecia Areata: A Retrospective Case Series and Literature Review

Alopecia areata (AA) is a common cause of hair loss in children. Despite numerous therapeutic options for paediatric AA, none have been found to be both effective and safe. Recent studies have demonstrated the efficacy and safety of the Janus kinase (JAK) inhibitor tofacitinib in adult patients with AA, whereas data on paediatric patients with AA in real-world practice are limited. This was a single-centre, retrospective study that included 11 pre-adolescent patients with AA treated with tofacitinib between December 2021 and September 2022. Clinical characteristics of patients, clinical response and adverse events were evaluated. Overall, 82% (9/11) of patients experienced hair regrowth and 64% (7/11) of patients experienced over 50% improvement in their Severity of Alopecia Tool (SALT) scores. Adverse events were mild. In the literature, tofacitinib has been used to treat AA in 31 children ≤12 years of age who failed to respond to prior treatments. Eighty-seven percent (27/31) of these patients showed significant responses based on changes in their SALT scores. This case series demonstrates that oral tofacitinib is an effective and safe treatment option for paediatric AA, particularly for children who have failed to respond to traditional treatments or are not suitable for such treatments. SIGNIFICANCE Recent studies have demonstrated the efficacy and safety of tofacitinib, a Janus kinase inhibitor, in adult patients with alopecia areata, whereas data on paediatric patients with alopecia areata in real-world practice are limited. This retrospective case series evaluated the efficacy of tofacitinib in 11 children with alopecia areata. Overall, clinical improvement was demonstrated in 9 patients (82%). In addition, a literature review was performed and 31 cases of pre-adolescent alopecia areata treated with tofacitinib were analysed. The results demonstrate that oral tofacitinib in the treatment of paediatric alopecia areata has significant clinical efficacy and safety, providing a novel alternative for children with alopecia areata who fail to respond to, or who cannot tolerate, traditional treatment.