Topical Tofacitinib Trialled As Children's Alopecia Areata Treatment
When it comes to the more severe forms of autoimmune alopecia, the fact that no Alopecia Totalis and Alopecia Universalis treatments exist which are truly effective is often hard for affected adults to deal with. But, for children with hair loss it can be even more difficult.
Whilst Alopecia Areata treatment for the scalp-only form of the condition can be treated in those aged 16 and over, those aged 15 and under currently have limited options.
One of the big questions that started being asked once JAK inhibitor treatments started to appear promising for regrowing hair in adults with all forms of Alopecia Areata, was 'will they be suitable for children?'.
Now, it would appear researchers in Philadelphia, USA, are currently trying to provide an answer.
The findings of a clinical trial were published in the Journal of the American Academy of Dermatology from the Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine.
Concerns regarding the potentially serious side effects of oral tofacitinib were considered sufficiently reduced in water-based 'liposomal' topical versions to warrant a small-scale paediatric study.
The University's team investigated the use of a topical 2 per cent solution of the JAK inhibitor tofacitinib on 11 patients - 2 boys and 9 girls - aged between 4 and 16 years of age. These children all had either scalp-only Alopecia Areata (AA), Alopecia Totalis (AT) or Alopecia Universalis (AU) - which cause baldness of the head, or from head to toe, respectively - that had been present for at least two years.
Seven of the participants had a family history of autoimmune disease and each had failed to see results from previous courses comprising drugs including prednisone, methotrexate and/or class 1 or 2 topical steroids.
Treatment, whereby the 2 per cent tofacitinib solution was applied directly to the affected areas of the scalp daily, took place for a mean duration of 34.5 weeks.
The trial reported mixed results in terms of success. Over the course of the study, changes to each child's hair was assessed using the Severity of Alopecia Tool (SALT). According to these SALT figures, 8 out of the 11 patients showed improved hair growth, and the test yielded an overall average reduction in hair loss of 32.3 per cent. Continues below...
Of the 11 children, one dropped out of the trial. Three were seen to have what researchers describe as 'cosmetically acceptable regrowth', which they determine as being 'sufficient to cover the scalp or able to conceal residual areas of hair loss'. Whilst two of the participants showed initial signs of progress, their hair regrowth reversed at the month 9-12 mark. One other patient did not respond to the topical solution so was offered oral tofacitinib (also known by the brand name Xeljanz) and responded positively.
Six of the ten children who finished the trial have decided to continue using the solution, and with the exception of one instance of scalp irritation where the solution was applied, no adverse reactions to the tofacitinib were reported.
The report authors conclude, 'These limited results suggest that topical tofacitinib might be a reasonable adjunct or second-line therapy for pediatric patients with AA, AT, and AU for whom systemic therapies are not desired. Controlled studies with larger cohorts are needed to determine efficacy and identify factors associated with favorable outcomes.'
JAK inhibitor hair loss treatments are not yet available for adults or children as they are still in development. Only once they have successfully completed each necessary clinical trial stage and then been granted the relevant MHRA license for the UK and FDA approval for the USA, will they become available for prescription use. Though all reports to date have showed that these trials appear to be progressing well, any set-backs will cause delays. However, for now the estimated release date for these treatments is thought to be the year 2021.
In the meantime, anyone concerned that their child is experiencing sudden or unusual hairloss of any kind should always consult their doctor as a first port of call. Additional information and support can be found from dedicated hair loss charities which can often be a source of great comfort, as well as - in the case of the Little Princess Trust and Hero by LPT - provide real-hair wigs free of charge.
Whilst Alopecia Areata treatment for the scalp-only form of the condition can be treated in those aged 16 and over, those aged 15 and under currently have limited options.
One of the big questions that started being asked once JAK inhibitor treatments started to appear promising for regrowing hair in adults with all forms of Alopecia Areata, was 'will they be suitable for children?'.
Topical tofacitinib 2% solution
The findings of a clinical trial were published in the Journal of the American Academy of Dermatology from the Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine.
Concerns regarding the potentially serious side effects of oral tofacitinib were considered sufficiently reduced in water-based 'liposomal' topical versions to warrant a small-scale paediatric study.
The University's team investigated the use of a topical 2 per cent solution of the JAK inhibitor tofacitinib on 11 patients - 2 boys and 9 girls - aged between 4 and 16 years of age. These children all had either scalp-only Alopecia Areata (AA), Alopecia Totalis (AT) or Alopecia Universalis (AU) - which cause baldness of the head, or from head to toe, respectively - that had been present for at least two years.
Seven of the participants had a family history of autoimmune disease and each had failed to see results from previous courses comprising drugs including prednisone, methotrexate and/or class 1 or 2 topical steroids.
Treatment, whereby the 2 per cent tofacitinib solution was applied directly to the affected areas of the scalp daily, took place for a mean duration of 34.5 weeks.
Mixed results
The trial reported mixed results in terms of success. Over the course of the study, changes to each child's hair was assessed using the Severity of Alopecia Tool (SALT). According to these SALT figures, 8 out of the 11 patients showed improved hair growth, and the test yielded an overall average reduction in hair loss of 32.3 per cent. Continues below...
Of the 11 children, one dropped out of the trial. Three were seen to have what researchers describe as 'cosmetically acceptable regrowth', which they determine as being 'sufficient to cover the scalp or able to conceal residual areas of hair loss'. Whilst two of the participants showed initial signs of progress, their hair regrowth reversed at the month 9-12 mark. One other patient did not respond to the topical solution so was offered oral tofacitinib (also known by the brand name Xeljanz) and responded positively.
The report authors conclude, 'These limited results suggest that topical tofacitinib might be a reasonable adjunct or second-line therapy for pediatric patients with AA, AT, and AU for whom systemic therapies are not desired. Controlled studies with larger cohorts are needed to determine efficacy and identify factors associated with favorable outcomes.'
JAK inhibitor hair loss treatments are not yet available for adults or children as they are still in development. Only once they have successfully completed each necessary clinical trial stage and then been granted the relevant MHRA license for the UK and FDA approval for the USA, will they become available for prescription use. Though all reports to date have showed that these trials appear to be progressing well, any set-backs will cause delays. However, for now the estimated release date for these treatments is thought to be the year 2021.
In the meantime, anyone concerned that their child is experiencing sudden or unusual hairloss of any kind should always consult their doctor as a first port of call. Additional information and support can be found from dedicated hair loss charities which can often be a source of great comfort, as well as - in the case of the Little Princess Trust and Hero by LPT - provide real-hair wigs free of charge.
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