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15489 JEADV
REVIEW ARTICLE
Abstract
There have been a number of case reports and small clinical trials reporting promising outcomes of Janus Kinase (JAK)
inhibitors tofacitinib, ruxolitinib and baricitinib for alopecia areata (AA). The majority of the literature to date is based on
small volume data, with a lack of definitive evidence or guidelines. To determine the expected response of AA to JAK
inhibitor therapy and factors which influence response and recurrence rates. A systematic review and meta-analysis was
performed according to PRISMA guidelines. From 30 studies and 289 cases, there were 72.4% responders, good
responders 45.7% and partial responders 21.4%. Mean time to initial hair growth was 2.2 6.7 months, and time to
complete hair regrowth was 6.7 2.2 months. All 37 recurrences occurred when treatment was ceased after
2.7 months. Oral route was significantly associated with response to treatment compared to topical therapy. No differ-
ence was found between paediatric and adult cases in proportion of responses. There is promising low-quality evidence
regarding the effectiveness of JAK inhibitors in AA. Future large-sized randomized studies are required to confirm findings.
Received: 3 October 2018; Accepted: 18 January 2019
Conflicts of Interest
None to declare.
Funding sources
None.
JEADV 2019, 33, 850–856 © 2019 European Academy of Dermatology and Venereology
JAK inhibitors for alopecia areata 851
Methods
2 months off
4 months off
Recurrence
lines. Electronic searches were performed using Ovid Medline,
PubMed, EMBASE, Cochrane Central Register of Controlled
–
Trials (CCTR), Cochrane Database of Systematic Reviews
(CDSR), ACP Journal Club and Database of Abstracts of
60.5% (17.2–100%)
32.9% (1.2–87.4%)
Review of Effectiveness (DARE) from their dates of inception
47.14 35.97%
64.7% (10–88%)
Median change:
Median change
56.3% reached
Mean change:
Mean change:
to July 2018. To achieve the maximum sensitivity of the search
SALT score
Change in
strategy, we combined the terms: ‘alopecia areata’ AND ‘JAK
SALT50
inhibitor’ OR ‘ruxolitinib OR tofacitinib OR baricitinib’ as
either key words or MeSH terms. The reference lists of all
retrieved articles were reviewed for further identification of
11.74 13.81
potentially relevant studies, assessed using the inclusion and
Duration of
treatment
7.5 (4–17)
9.5 3.5
(months)
12 (4–18)
exclusion criteria.
–
Selection criteria
Eligible studies for the present systematic review and meta-ana-
PO tofacitinib
PO tofacitinib
PO tofacitinib
lysis included those in which patient from case reports, case ser-
Table 1 Characteristics and outcomes of included studies in the present systematic review and meta-analysis
Treatment
AA, alopecia areata; AT, alopecia totalis; AU, alopecia universalis; BD, twice a day; PO, oral; SALT, Severity of Alopecia Tool.
5 mg BD
5 mg BD
5 mg BD
5 mg BD
ies, cohort studies or clinical trials with AA/AU/AT were treated
with JAK inhibitor therapy. Studies that did not report response
or complications as endpoints were excluded. All publications
were limited to those involving human subjects. Language was
10.54 10.66
Duration of
18 (2–54)
Alopecia
8 (1–35)
torials, reviews and expert opinions were excluded. The search
(years)
16/33 (48.5%)
40/90 (44.4%)
23/32 (71.9%)
25/92 (27.2%)
Data extraction
All data were extracted from article texts, tables and figures. Two
investigators independently reviewed each retrieved article (K.P.,
Men
31.2 9.3
37 (19–65)
30 (18–54)
33
90
32
92
N
AA
AA
AA
Cohort
Cohort
Cohort
Study
study
study
study
type
Statistical analysis
2015–2018
2018
2017
2017
Year
Pooled
Crispin
cases
Liu
JEADV 2019, 33, 850–856 © 2019 European Academy of Dermatology and Venereology
852 Phan and Sebaratnam
Meta-analysis was performed using the meta for package for R After detailed evaluation of these articles, a total of 30 arti-
version 3.3. cles6,7,11–38 were included in the present study, comprising four
For individual patient level data, the data were analysed using cohort studies (comprising 221 patients) and 26 case reports/
descriptive statistics. Univariate analysis was performed according to case series/trials with individual patient level data (comprising
factors: responders vs. non-responders, good versus partial respon- 92 patients).
ders and paediatric versus adult cases. Correlation analysis was per- Summary characteristics of included cohort studies are found in
formed using Spearman correlation. Time to event (hair regrowth) Table 1, and of the pooled individual cases from case reports/series
was analysed using Kaplan–Meier analysis. All analyses were per- in Table 1 and Table S2. Mean age ranged from 30 to 37 years,
formed using the meta for package for R version 3.4 or SPSS version proportion of men ranged from 27.2% to 71.9%. The duration of
24. P values < 0.05 were considered statistically significant. alopecia ranged from 5 to 18 months. Treatment duration ranged
from 7.5 to 12 months. From the pooled individual case data, 14
Results cases (26.9%) had prior failed systemic therapy, for example with
A total of 196 studies were identified through six electronic data- methotrexate. Nine cases (9.8%) had a major autoimmune comor-
base searches and from other sources such as reference lists (Fig- bidity including psoriasis, psoriatic arthritis and thyroid disease.
ure S1). After exclusion of duplicate or irrelevant references, 85 From pooled case data, the most common treatments were oral
potentially relevant articles were retrieved. There were some tofacitinib (45 cases, 48.9%), followed by topical tofacitinib (25
studies with overlapping populations that were removed.5,9,10 cases, 27.2%) and oral ruxolitinib (17 cases, 18.5%).
(a)
Studies
Crispin 2016
Lee 2018
Liu 2017
Park 2017
Pooled cases 2015−2018
(b)
Studies
Crispin 2016
Park 2017
Pooled cases 2015−2018
(c)
Studies
Crispin 2016
Park 2017
Pooled cases 2015−2018
Figure 1 Pooled meta-analysis of proportion of patients with (a) any positive response (5–100%), (b) good response (50–100%) and
(c) partial response (5–50%) hair growth to JAK inhibitor therapy for alopecia areata.
JEADV 2019, 33, 850–856 © 2019 European Academy of Dermatology and Venereology
JAK inhibitors for alopecia areata 853
Efficacy of JAK inhibitors for alopecia areata recurrences occurred when JAK inhibitor therapy was ceased, on
Pooled meta-analysis based on data from cohort studies and case average, after 2.7 months. Characteristics of recurrent cases are
reports of responders to JAK inhibitor therapy is shown in Fig. 1. summarized in Table S3.
Based on a total of 289 patients, the proportion of patients with
any response was 72.4% (95% CI 64.5–79.2%). The proportion of Predictors of response to JAK inhibitor therapy
patients with good response was 45.7% (95% CI 31.7–60.3%) and We performed univariate analysis to determine predictors of
the proportion of patients with partial responses was 21.4% (95% responders to JAK inhibitor therapy for alopecia areata. Oral
CI 12.4–34.4%). From the pooled case data, the mean time to ini- JAK inhibitors were significantly associated with response to
tial hair growth was 2.2 6.7 months, and time to complete hair treatment compared to topical therapy (77.8% vs. 46.4%,
regrowth in those cases that did was 6.7 2.2 months (Table S1). P = 0.003), with odds ratio 4.0 (95% CI 1.56–10.45) as reported
There were 12 cases of recurrence of alopecia areata from the in Table 2. There was no difference between responders and
pooled cases, and 25 recurrences from the cohort studies. All 37 non-responders in terms of age, sex, duration of AA, AA sub-
type, JAK inhibitor, nor the duration of treatment.
Table 2 Comparing characteristics and outcomes of Responders We performed univariate analysis to determine predictors of
versus Non-responders to JAK inhibitors for alopecia areata,
good responders versus partial responders, summarized in
based on pooled case reports/case series
Table 3. Again, only oral treatment route was significantly asso-
Parameter Responder Non-responder P-value ciated with good response (85.4% vs. 42.9%, P = 0.001) with an
N 63 28 – odds ratio of 7.8 (95% CI 2.07–29.41). There was no difference
Men 18 (28.6%) 7 (25%) 0.223 between responders and non-responders in terms of age, sex,
Women 33 (52.4%) 11 (39.3%) —
duration of AA, AA subtype, JAK inhibitor, nor the duration of
Age (years) 31.54 15.48 26.89 18.21 0.304
treatment. Time to initial hair regrowth was also similar between
Duration of 10.66 10.50 9.63 11.47 0.741
alopecia (years)
these two groups.
AA 41 (65.1%) 19 (67.9%) 0.449
We compared demographics and outcomes of men versus
AU 19 (30.2%) 6 (21.4%) — women (Table S4). Although there was a significant difference in
AT 3 (4.8%) 3 (10.7%) — the proportion of AA, AU and AT cases, we found no differences
Failed systemic 10 (26.3%) 4 (28.6%) 0.871 in the route of therapy used, nor the proportion of responders,
therapy good or partial responses. The % change in SALT score was also
Major autoimmune 8 (12.7%) 1 (3.6%) 0.178 similar between men and women.
comorbidity
Correlation analysis found that age, duration of AA, duration
Treatment route
of treatment, initial SALT score, nor time to initial hair growth
Topical 14 (22.2%) 15 (53.6%) 0.003
were not significant predictors of change in SALT score with
Oral 49 (77.8%) 13 (46.4%) —
JAK inhibitor therapy (Table S7).
Topical (n = 29)
Topical tofacitinib 12 (85.7%) 13 (86.7%) 0.941
Comparison of JAK inhibitors for alopecia in paediatric
Topical ruxolitinib 2 (14.3%) 2 (13.3%) —
Oral (n = 62)
versus adult populations
Oral tofacitinib 34 (69.4%) 10 (76.9%) 0.794
The duration of AA was shorter in paediatric cases compared
Oral ruxolitinib 14 (28.6%) 3 (23.1%) — with adults (4.03 vs. 13.7 years, P = 0.001; Table S5). Paediatric
Oral baricitinib 1 (1.6%) 0 (0%) — cases were also associated with higher proportion of AU and AT
Mean duration of 13.19 15.56 8.47 8.01 0.134 (P < 0.001). Topical JAK inhibitors were used in 89.5% of pae-
treatment (months) diatric cases compared to 4.1% of adult cases (P < 0.001). The
Outcome average duration of treatment was also significantly longer for
Good response 48 (78.7%) – – paediatric cases (23.7 vs. 9.0 months, P < 0.001). However, the
Partial response 13 (21.3%) – – proportion of responders, good and partial responders, as well
Recurrences 12 (19.0%) – – as recurrence and changes in SALT scores were comparable and
Time to initial 2.16 1.92 – – not significantly different between the two groups (Table S5).
regrowth (months)
Time to complete 6.67 2.19 – –
regrowth (months)
Comparison of JAK inhibitors for alopecia areata variants
Change in SALT (%) 47.14 35.97% – –
Demographics and outcomes with JAK inhibitors in AA were
compared with the more severe AT and AU (Table S6). We
AA, alopecia areata; AT, alopecia totalis; AU, alopecia universalis; N, num-
ber of cases; SALT, Severity of Alopecia Tool; Data expressed as n(%) or
found that higher proportion patients with AA received oral
mean standard deviation. One case (n = 1) was excluded due to inade- agents compared to patients with AT/AU. Despite this, compa-
quate assessment of response due to drop-out from follow-up. rable proportions of patients achieved any response in AA and
JEADV 2019, 33, 850–856 © 2019 European Academy of Dermatology and Venereology
854 Phan and Sebaratnam
JEADV 2019, 33, 850–856 © 2019 European Academy of Dermatology and Venereology
JAK inhibitors for alopecia areata 855
In our analysis, we did not find significant difference in simple combination of their results does not ameliorate this.
response rates, changes in SALT score, or time profile of There is also significant selection bias and publication bias, given
response in men compared with women. Similarly, we also that it is likely that only positive results are published. A small
found similar response rates, good response or partial response sample size of patients also limits statistical power of analysis.
in paediatric cases compared with adult cases. This is in spite of We acknowledge that a meta-analysis of clinical cases does not
the paediatric group having a lower proportion of cases with oral replace the degree of evidence provided by randomized clinical
JAK inhibitor treatment. These findings are supportive of the trials; however, it does serve as a hypothesis generator to explore
efficacy of topical treatment in young patients. In adult cases, some clinical questions regarding the use of JAK inhibitors in
topical treatment may be first line for those with mild-to-mod- AA that have not been investigated thus far in case series and trials.
erate AA disease, or as an adjunct or second-line therapy. In summary, the current evidence to date is low-quality in
In our systematic review, we found an overall low complica- nature but is promising regarding the efficacy and safety of JAK
tion rate. The most common side-effect was infections in the inhibitors in the treatment of AA. Patients need to maintain JAK
form of upper respiratory tract infections and urinary tract infec- inhibitor treatment in order for hair regrowth to be sustained.
tions. There were no cases of new malignancies or reactivation of Further studies are required to better understand factors influ-
tuberculosis. Laboratory changes were minimal, and most com- encing JAK inhibitor treatment outcomes in patients with AA
mon were mild transaminitis, mild lipid abnormalities and and its subtypes.
cytopenias, although the prevalence was low. As complication
rates were low, we did not find any significant difference in com- Ethics approval
plication profiles between oral versus topical JAK inhibitors, Not required as this is a systematic review.
although intuitively topical agents would be of lower risk. Topical
agents may be the more appealing treatment option in paediatric References
population, with lower theoretical risk of complications compared 1 McMichael AJ, Pearce DJ, Wasserman D et al. Alopecia in the United
States: outpatient utilization and common prescribing patterns. J Am
to oral agents, but the ability to achieve similar outcomes com-
Acad Dermatol 2007; 57: S49–S51.
pared to adult AA/AU/AT on oral JAK inhibitor treatment. 2 Safavi KH, Muller SA, Suman VJ, Moshell AN, Melton LJ 3rd. Incidence
Although there is limited safety data of JAK inhibitors in the of alopecia areata in Olmsted County, Minnesota, 1975 through 1989.
context of AA, there is increasing evidence of its safety profile in Mayo Clin Proc 1995; 70: 628–633.
3 Colon EA, Popkin MK, Callies AL, Dessert NJ, Hordinsky MK. Lifetime
rheumatology and rheumatoid arthritis. In a study of over 5000
prevalence of psychiatric disorders in patients with alopecia areata.
patients and over 12 000 person-years of exposure to tofacitinib, Compr Psychiat 1991; 32: 245–251.
there were 107 reported cases of malignancy, which are similar 4 Phan K, Ramachandran V, Sebaratnam DF. Methotrexate for alopecia
to rates reported for the use of biologic agents.39,40 More unique areata: a systematic review and meta-analysis. J Am Acad Dermatol 2018;
80: 120–127.e2.
to tofacitinib compared to biologic therapy, there appears to be 5 Xing L, Dai Z, Jabbari A et al. Alopecia areata is driven by cytotoxic T
an increased risk of viral reactivation particularly with herpes lymphocytes and is reversed by JAK inhibition. Nat Med 2014; 20:
zoster infections, with twofold higher risk compared to use of 1043–1049.
biologic agents in rheumatoid arthritis patients.41,42 This risk 6 Jabbari A, Dai Z, Xing L et al. Reversal of alopecia areata following treat-
ment with the JAK1/2 inhibitor baricitinib. EBioMedicine 2015; 2: 351–355.
appears to be dose dependent, with significantly higher risk 7 Mackay-Wiggan J, Jabbari A, Nguyen N et al. Oral ruxolitinib induces
when used as doses 10 mg twice daily.41 Tuberculosis reactiva- hair regrowth in patients with moderate-to-severe alopecia areata. JCI
tion has also been reported with tofacitinib43 and baricitinib.44 Insight 2016; 1: e89790.
8 Petukhova L, Duvic M, Hordinsky M et al. Genome-wide association
Gastrointestinal perforation is another serious complication that
study in alopecia areata implicates both innate and adaptive immunity.
has been reported with incidence of 1.29 cases per 1000 patient- Nature 2010; 466: 113–117.
years in rheumatoid arthritis patients treated with tofacitinib.45 9 Craiglow BG, Liu LY, King BA. Tofacitinib for the treatment of alopecia
As such, it is important to emphasis for clinicians using JAK areata and variants in adolescents. J Am Acad Dermatol 2017; 76: 29–32.
10 Liu LY, King BA. Tofacitinib for the treatment of severe alopecia
inhibitors that the possibility of serious and lethal adverse effects
areata in adults and adolescents. J Investig Dermatol Symp Proc 2018;
is very plausible, and that safety profile data for this class of 19: S18–S20.
agents in AA are still in its infancy. 11 Anzengruber F, Maul JT, Kamarachev J, Trueb RM, French LE, Navarini
The present findings are limited by several constraints. This AA. Transient efficacy of tofacitinib in alopecia areata universalis. Case
Rep Dermatol 2016; 8: 102–106.
meta-analysis was based on available low-quality evidence, pre-
12 Bayart CB, DeNiro KL, Brichta L, Craiglow BG, Sidbury R. Topical Janus
dominantly in the form of case reports. These findings require kinase inhibitors for the treatment of pediatric alopecia areata. J Am Acad
confirmation in large cohort or database studies, with prospec- Dermatol 2017; 77: 167–170.
tive follow-up and evaluation. Findings are also susceptible to 13 Craiglow BG, King BA. Killing two birds with one stone: oral tofacitinib
reverses alopecia universalis in a patient with plaque psoriasis. J Invest
observer bias as a result of clinician and study participants being Dermatol 2014; 134: 2988–2990.
unblinded during treatment and outcomes assessment. Case 14 Craiglow BG, Tavares D, King BA. Topical ruxolitinib for the treatment
reports and small case series have a high risk of bias, and the of alopecia universalis. JAMA Dermatol 2016; 152: 490–491.
JEADV 2019, 33, 850–856 © 2019 European Academy of Dermatology and Venereology
856 Phan and Sebaratnam
15 Kennedy Crispin M, Ko JM, Craiglow BG et al. Safety and efficacy of the 36 Vandiver A, Girardi N, Alhariri J, Garza LA. Two cases of alopecia areata
JAK inhibitor tofacitinib citrate in patients with alopecia areata. JCI treated with ruxolitinib: a discussion of ideal dosing and laboratory moni-
Insight 2016; 1: e89776. toring. Int J Dermatol 2017; 56: 833–835.
16 Deeb M, Beach RA. A case of topical ruxolitinib treatment failure in 37 Vu M, Heyes C, Robertson SJ, Varigos GA, Ross G. Oral tofacitinib: a
alopecia areata. J Cutaneous Med Surgery 2017; 21: 562–563. promising treatment in atopic dermatitis, alopecia areata and vitiligo.
17 Dhayalan A, King BA. Tofacitinib citrate for the treatment of nail dystrophy Clin Exp Dermatol 2017; 42: 942–944.
associated with alopecia universalis. JAMA Dermatol 2016; 152: 492–493. 38 Ramot Y, Zlotogorski A. Complete regrowth of beard hair with ruxolitinib
18 Erduran F, Adisen E, Aksakal AB. Excellent response to tofacitinib treat- in an alopecia universalis patient. Skin Appendage Disord 2018; 4: 122–124.
ment in a patient with alopecia universalis. Acta Dermatovenerologica 39 Curtis JR, Lee EB, Kaplan IV et al. Tofacitinib, an oral Janus kinase inhi-
Alpina, Pannonica, et Adriatica 2017; 26: 47–49. bitor: analysis of malignancies across the rheumatoid arthritis clinical
19 Ferreira SB, Scheinberg M, Steiner D, Steiner T, Bedin GL, Ferreira RB. development programme. Ann Rheum Dis 2016; 75: 831–841.
Remarkable improvement of nail changes in alopecia areata universalis 40 Weinblatt ME, Moreland LW, Westhovens R et al. Safety of abatacept
with 10 months of treatment with tofacitinib: a case report. Case Rep Der- administered intravenously in treatment of rheumatoid arthritis: inte-
matol 2016; 8: 262–266. grated analyses of up to 8 years of treatment from the abatacept clinical
20 Gupta AK, Carviel JL, Abramovits W. Efficacy of tofacitinib in treatment trial program. J Rheumatol 2013; 40: 787–797.
of alopecia universalis in two patients. J Eur Acad Dermatol Venereol 41 Winthrop KL, Yamanaka H, Valdez H et al. Herpes zoster and tofacitinib
2016; 30: 1373–1378. therapy in patients with rheumatoid arthritis. Arthritis Rheumatol (Hobo-
21 Harris JE, Rashighi M, Nguyen N et al. Rapid skin repigmentation on oral ken, NJ) 2014; 66: 2675–2684.
ruxolitinib in a patient with coexistent vitiligo and alopecia areata (AA). J 42 Curtis JR, Xie F, Yun H, Bernatsky S, Winthrop KL. Real-world
Am Acad Dermatol 2016; 74: 370–371. comparative risks of herpes virus infections in tofacitinib and bio-
22 Higgins E, Al Shehri T, McAleer MA et al. Use of ruxolitinib to success- logic-treated patients with rheumatoid arthritis. Ann Rheum Dis
fully treat chronic mucocutaneous candidiasis caused by gain-of-function 2016; 75: 1843–1847.
signal transducer and activator of transcription 1 (STAT1) mutation. J 43 Winthrop KL, Park SH, Gul A et al. Tuberculosis and other opportunistic
Allergy Clin Immunol 2015; 135: 551–553. infections in tofacitinib-treated patients with rheumatoid arthritis. Ann
23 Ibrahim O, Bayart CB, Hogan S, Piliang M, Bergfeld WF. Treatment of Rheum Dis 2016; 75: 1133–1138.
alopecia areata with tofacitinib. JAMA Dermatol 2017; 153: 600–602. 44 Genovese MC, Kremer JM, Zamani O et al. Baricitinib, an oral Janus
24 Jabbari A, Sansaricq F, Cerise J et al. An open-label pilot study to evaluate Kinase (JAK)1/JAK2 inhibitor, in patients with active Rheumatoid Arthri-
the efficacy of tofacitinib in moderate to severe patch-type alopecia areata, tis (RA) and an inadequate response to TNF inhibitors: results of the
totalis, and universalis. J Invest Dermatol 2018; 138: 1539–1545. phase 3 RA-beacon study. Ann Rheum Dis 2015; 74(Suppl 2): 753–776.
25 Jabbari A, Nguyen N, Cerise JE et al. Treatment of an alopecia areata 45 Xie F, Yun H, Bernatsky S, Curtis JR. Brief report: risk of gastrointestinal
patient with tofacitinib results in regrowth of hair and changes in serum perforation among rheumatoid arthritis patients receiving tofacitinib,
and skin biomarkers. Exp Dermatol 2016; 25: 642–643. tocilizumab, or other biologic treatments. Arthritis Rheumatol (Hoboken,
26 Lee JS, Huh CH, Kwon O, Yoon HS, Cho S, Park HS. Nail involvement in NJ) 2016; 68: 2612–2617.
patients with moderate-to-severe alopecia areata treated with oral tofaci-
tinib. J Dermatol Treatment 2018; 29: 819–822.
Supporting information
27 Liu LY, Craiglow BG, King BA. Tofacitinib 2% ointment, a topical Janus
kinase inhibitor, for the treatment of alopecia areata: a pilot study of 10 Additional Supporting Information may be found in the online
patients. J Am Acad Dermatol 2018; 78: 403–404 e401. version of this article:
28 Liu LY, Craiglow BG, Dai F, King BA. Tofacitinib for the treatment of
severe alopecia areata and variants: a study of 90 patients. J Am Acad Der- Figure S1. PRISMA search strategy for the present systematic
matol 2017; 76: 22–28. review and meta-analysis
29 Mrowietz U, Gerdes S, Glaser R, Schroder O. Successful treatment of
Table S1. Search strategy employed in Ovid Medline.
refractory alopecia areata universalis and psoriatic arthritis, but not of
plaque psoriasis with tofacitinib in a young woman. Acta Dermato-vener- Table S2. Summary demographics and outcomes from individ-
eologica 2017; 97: 283–284. ual patient data from pooled cases.
30 Park HS, Kim MW, Lee JS et al. Oral tofacitinib monotherapy in Korean Table S3. Demographics and treatment characteristics of recur-
patients with refractory moderate-to-severe alopecia areata: a case series. J
rent cases following JAK inhibitor therapy for alopecia areata,
Am Acad Dermatol 2017; 77: 978–980.
31 Patel NU, Oussedik E, Grammenos A, Pichardo-Geisinger R. A case based on pooled case reports/case series.
report highlighting the effective treatment of alopecia universalis with Table S4. Demographics and treatment outcomes of male versus
tofacitinib in an adolescent and adult patient. J Cutaneous Med Surg 2018; female cases, based on pooled case reports/case series.
22: 439–442.
Table S5. Demographics and treatment outcomes of pediatric
32 Pieri L, Guglielmelli P, Vannucchi AM. Ruxolitinib-induced reversal of
alopecia universalis in a patient with essential thrombocythemia. Am J (age <18 years) versus adult (age ≥18 years) cases, based on
Hematol 2015; 90: 82–83. pooled case reports/case series.
33 Putterman E, Castelo-Soccio L. Topical 2% tofacitinib for children with Table S6. Demographics and treatment characteristics of alope-
alopecia areata, alopecia totalis, and alopecia universalis. J Am Acad Der-
matol 2018; 78: 1207–1209 e1201.
cia areata versus alopecia totalis/alopecia universalis cases on
34 Salman A, Sarac G, Ergun T. Alopecia universalis unresponsive to treat- JAK inhibitor therapy.
ment with tofacinitib: report of a case with a brief review of the literature. Table S7. Correlation analysis of patient characteristics versus %
Dermatol Online J 2017; 23: 13030/qt224878kb. change in SALT score following JAK inhibitor treatment for
35 Scheinberg M, de Lucena Couto Ocea RA, Cruz BA, Ferreira SB. Brazilian
experience of the treatment of alopecia universalis with the novel anti- alopecia areata, based on pooled case reports/case series.
rheumatic therapy tofacitinib: a case series. Rheumatol Therapy 2017; 4: Table S8. Adverse effects and complications of JAK inhibitor
503–508. therapy for alopecia areata.
JEADV 2019, 33, 850–856 © 2019 European Academy of Dermatology and Venereology