Pilot Oral Ruxolitinib Study Sees Severe Alopecia Areata Hair Regrowth

The results of a study into the use of a Janus Kinase (JAK) inhibitor drug as a treatment for all forms of Alopecia Areata (AA), the autoimmune disorder that leads to varying degrees of hair loss, have just been announced.

And the findings are promising especially given the credentials of the researchers behind the study. The trial was small in scale, involving just 12 patients with moderate Alopecia Areata - patchy hair loss of the scalp only, Alopecia Totalis - total baldness of the scalp usually accompanied by loss of facial hair, eyebrows and eyelashes, and Alopecia Universalis - the most extreme form of AA which causes the entire body from head to toe to become totally hairless. Whilst existing treatment options for AA can be incredibly effective, there are currently no available worthwhile treatment options for AT and AU.

The clinical trial was overseen by a much-respected team at Columbia University in New York, where hair loss expert Dr Angela M Christiano has been a leading light in exploring the use of JAK inhibitors as possible treatment options for Alopecia Areata and its related conditions.

For the study, patients were given the JAK inhibitor drug called Ruxolitinib (brand name: Jakafi) orally, twice a day, for three-to-six months. They were then observed for a further three months after they had stopped taking the pills.

"Remarkable response"

Nine of the 12 patients so 75 per cent demonstrated what the researchers described as “a remarkable response to treatment”, with an average hair regrowth of 92 per cent. The report published in the Journal of Clinical Investigation states that “safety parameters remained largely within normal limits, and no serious adverse effects were reported. Gene expression profiling revealed treatment-related downregulation of inflammatory markers.” Continues below

Columbia University before (a) and after (b) photographs show volunteers' ruxolitinib treatment regrowth

Much has been made over the past few years of Alopecia Areata’s relationship with inflammation, and the latest study seems to support the idea that reducing inflammation may be a way to reduce the effects of Alopecia Areata.

At a basic level, this link may be interpreted something like this:

• Alopecia Areata is widely believed to be an autoimmune disorder


• Autoimmune disorders cause the body’s immune system to attack healthy cells (in the scalp, in this case) in the belief that they are enemy cells


• An attack by the immune system can lead to inflammation


• Inflammation may be exactly what is causing the hair to fall out


• Inflammation can be suppressed by drugs like Ruxolitinib


• The cells in the scalp are thus allowed to recover and hair growth can resume.

The Columbia trial findings are certainly an encouraging step, and the team are now calling for larger, randomised trials “to further assess the safety and efficacy of Ruxolitinib in the treatment of Alopecia Areata.”

The “safety” part of that equation is paramount and may well prove to be the thing that delays the drug’s availability to a wider market. Developed as a treatment for specific cancers, Ruxolitinib like other JAK inhibitors is a potent drug which comes with the possibility of some severe side effects. This is why the drug is being investigated for topical use in cream form.

Step in the right direction?

Some people wonder if using powerful drugs with possible side-effects to treat what is sometimes seen as “a cosmetic problem” is actually a step in the right direction. It may, however, be the case that the assorted teams around the world investigating JAK inhibitors for use on all forms of autoimmune hair loss are hoping to modify the drugs and reduce the chance of side-effects.

Although trials are looking positive, they are in the very early stages so there is still a long way to go until ruxolitinib treatment for alopecia areata could possibly be a realistic option. The earliest estimated timeline is currently rumoured to be 2020. For now, customised alopecia areata treatment course can, however, often promote regrowth in cases of mild-to-moderate, patchy hair loss for over 16s.

At Belgravia this approach typically incorporates high strength minoxidil applied directly to the bald patches, which can also be combined with a number of hair growth boosters. Clients with Alopecia Areata frequently remark on how helpful it is to be surrounded by a team of experts during such a troubling phase of their lives.

Anyone under 16 years of age or who has AT or AU is recommended to visit their GP or dermatologist. Support for dealing with these conditions, which can often deeply affect a person psychologically, is also available from a number of hair loss charities, including Alopecia UK and, for children, the Little Princess Trust.