Arthritis Drug Xeljanz Used to Treat Alopecia Universalis
added 10th September 2014
American scientists are reporting a breakthrough in the treatment of hair loss from Alopecia Universalis.
During a study at America’s elite Yale University, the Arthritis drug, tofacitinib citrate was successfully used by a team from Yale’s School of Medicine to treat a bald patient suffering from Alopecia Universalis and plaque psoriasis. The 25 year old male patient was totally bald when he started the treatment, apart from a small number of hairs found within psoriasis plaques on his scalp.
The patient underwent an 8 month course of tofacitinib citrate in oral, tablet form, with 10mg per day for two months, then 15mg per day for a further three months. This treatment was found to be only ‘mildly effective’ in relation to treating his psoriasis, but appeared to completely cure his Alopecia Universalis. By the end of the course, the patient had grown hair for the first time in seven years.
There is currently no cure for Alopecia Universalis, the most severe and rare type of alopecia which is caused by a genetic chromosome mutation and leads to a complete loss of hair on the body and scalp, yet this patient managed to develop eyebrows, eyelashes, facial and body hair as well as a full head of hair across his scalp.
The Yale study’s co-author, dermatologist Brittany G. Craiglow, M.D. said, “By eight months there was full regrowth of hair. The patient has reported feeling no side effects, and we’ve seen no lab test abnormalities, either.”
The Janus-associated kinase (JAK) inhibitor, tofacitinib citrate, was approved by the FDA in 2012 for the treatment of moderate to severe cases of rheumatoid arthritis in adults. Xeljanz is currently FDA-approved for the treatment of rheumatoid arthritis in the USA and has also received similar approvals for use in Argentina, Columbia, Kuwait, the United Arab Emirates, Russia and Switzerland. Japan has also approved tofacitinib citrate for this type of treatment in adults, where it goes by the brand name Jaquinus. The drug is currently unavailable in the UK as it has not been granted a license by the Medicines and Healthcare products Regulatory Agency (MHRA).
An important point to note regarding tofacitinib is that it has been dogged by complaints, both about the cost of the drug, and – more worryingly – about its serious side effects. The side effects of Xeljanz include serious infections, tuberculosis and cancer. Currently scheduled to run until November 2019, on-going clinical trials for Xeljanz have so far resulted in four deaths, however the drug’s manufacturer, Pfizer, said that only one of these deaths was related to tofacitinib.
Yale study author, Brett A. King, M.D., assistant professor of dermatology at Yale University School of Medicine, advised: “The results are exactly what we hoped for. This is a huge step forward in the treatment of patients with this condition. While it’s one case, we anticipated the successful treatment of this man based on our current understanding of the disease and the drug. We believe the same results will be duplicated in other patients, and we plan to try… There are no good options for long-term treatment of alopecia universalis. The best available science suggested this might work, and it has.”
Dr. King has proposed a clinical trial involving a cream form of tofacitinib as a treatment for alopecia areata. Meanwhile, Phase III clinical trials for the study into the Long-Term Effectiveness And Safety Of Tofacitinib For The Treatment Of Rheumatoid Arthritis are currently under way, with results due in 2019. However, the Phase II trials tested Xeljanz in Rheumatoid Arthritis patients that had not responded to other therapy and found the most important side effects to be increased blood cholesterol levels (12 to 25 mg/dl LDL and 8 to 10 mg/dl HDL at medium dosage levels) and neutropenia, a granulocyte disorder whose key symptom is a deficit of white blood cells which can then lead to an increased risk of infection.
When taken as a rheumatoid arthritis medication, the most common side effects of Xeljanz were found to be upper respiratory tract infections, headaches, hypertension, diarrhoea and inflammation of the nasal passage (nasopharyngitis). However, the Safety & Side Effects warnings on the product’s website and packaging clearly state that ‘Xeljanz may cause serious side effects’. They list these as ‘Serious infections’… ‘including tuberculosis (TB), and infections caused by bacteria, fungi, or viruses that can spread throughout the body. Some people have died from these infections’; ‘Cancer and Immune System Problems’ and ‘Tears (perforation) in the Stomach or Intestines’.
The most effective treatment for Alopecia Universalis was previously thought to be Topical Immunotherapy. This has around a 40% success rate and needs to be ongoing for hair growth to continue. Reported side effects from Topical Immunotherapy, including persistent dermatitis, generalized eczema and blistering, can also be unpleasant.
We await the outcome of the on-going clinical trials for Xeljanz as a treatment for alopecia with great interest as, if the side effects and safety aspects can be dealt with satisfactorily, this could be a huge innovation for hair loss treatment, bringing hope to Alopecia Universalis sufferers everywhere.