Subscribe in a reader
Alopecia
universalis occurs in approximately one in every 200,000 people. It is thought
to be an auto immune disorder and can affect anyone at any age, long considered untreatable.
An
arthritis drug Tofacitinib citrate (trade names Xeljanz and Jakvinus, formerly tasocitinib
or CP-690550 & developed at Pfizer) was used to treat the
25-year-old man Kyle Rhodes from Killingworth who had lost most of his hair of
the scalp, face and body by his 18th birthday, after getting
alopecia universalis – a disease there is currently no long-term treatment or
cure for. The only hair on his
body was within the psoriasis plaques on his head.
Kyle Rhodes visited Assistant Professor
of Dermatology at Yale University School of Medicine, Dr. Brett King late last summer, seeking help for a severe case of plaque
psoriasis & associated Alopecia
universalis. The man had not grown hair for seven years. However, after
being treated with Tofacitinib just
three months, he had regrown a head of hair, eyebrows, eyelashes, some facial
hair and armpit hair. This
is a huge step forward in the treatment of patients with this condition.
The patient's head a)
before treatment with Tofacitinib, b) two months into treatment, c) five months
into treatment, and d) eight months into treatment. Yale University
King believed it
might be possible to address both diseases simultaneously using an existing
FDA-approved drug for rheumatoid arthritis called Tofacitinib citrate. The drug
had been used successfully for treating psoriasis in humans. It had also
reversed alopecia areata, a less extreme form of alopecia, in mice as studied
(but not published) by Columbia University scientist Angela Christiano.
After two months on Tofacitinib at 10 mg daily, the patient’s psoriasis showed some improvement,
and the man had grown scalp and facial hair — the first hair he’d grown there
in seven years. After three more months of therapy at 15 mg daily, the patient
had completely regrown scalp hair and also had clearly visible eyebrows,
eyelashes, and facial hair, as well as armpit and other hair. By eight months
there was full regrowth of hair, The patient has reported feeling no side
effects, and lab test showed no abnormalities, either.
It is believed that Tofacitinib
appears to spur hair regrowth in a patient with alopecia universalis by turning
off the immune system attack on hair follicles that is prompted by the disease.
King has submitted a
proposal for a clinical trial involving a cream form of tofacitinib as a
treatment for alopecia areata. A topical formulation has yet to be
developed and will be difficult to develop due to the large size of the
molecule involved and consequent difficulty in penetrating the scalp skin.
The paper is titled
“Killing Two Birds with One Stone: Oral Tofacitinib reverses Alopecia
Universalis in a Patient with Plaque Psoriasis.”
Mechanism of action
Tofacitinib
is an inhibitor of the
enzyme janus kinase 3
(JAK3), & it interferes with the
JAK-STAT signaling pathway, which transmits extracellular information
into the cell nucleus, influencing DNA transcription.
Recently
it has been shown in a murine model of established arthritis that Tofacitinib
rapidly improved disease by inhibiting the production of inflammatory mediators
and suppressing STAT1-dependent
genes in joint tissue. Tofacitinib may exert therapeutic benefit via pathways
that are not exclusive to inhibition of JAK3. In November 2012, the
U.S. FDA approved Tofacitinib for treatment of rheumatoid arthritis. Once on
the market, rheumatologists complained that the $2,055 a month wholesale price
was too expensive.
Possible side effects:
The most important side effects in Phase II studies were increased blood cholesterol levels and neutropenia. Phase III
trials testing the drug in rheumatoid arthritis started in 2007 and are
scheduled to run until January 2015. In April 2011, four patients died after
beginning clinical trials with tofacitinib. By April 2011, three phase III
trials for RA had reported positive results. In November 2012, the U.S. FDA
approved Tofacitinib "to treat adults with moderately to severely active
rheumatoid arthritis (RA) who have had an inadequate response to, or who are
intolerant of, Methotrexate." A boxed warning that goes along with this
approval warns patients that they are at higher
risk of opportunistic infections, tuberculosis, cancers and lymphoma.
The paper is titled
“Killing Two Birds with One Stone: Oral Tofacitinib Reverses Alopecia
Universalis in a Patient with Plaque Psoriasis.”