Xeljanz and Minoxidil for the treatment of alopecia

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The Yale University School of Medicine has published the latest results of a study regarding the treatment of severe alopecia areata, such as universal alopecia, with oral Xeljanz and minoxidil.

During a study performed on a small scale, this drug combination was found to promotehair growth..

12 patients undergoing the treatment were examined of which, two-thirds of these had75% hair growth.

One of the Yale team’s first discoveries onJanus kinase inhibition (JAK inhibition) for the treatment of disorders such as Alopecia areata and universal, were conducted on the drugXeljanz.

Xeljanz is the brand name for the JAK inhibitor tofacitinib, manufactured by Pfizer and currently used to treat conditions such as rheumatoid arthritis. Since 2014, several companies have tested it as a possible solution for alopecia areata, both orally and topically.

High-dose minoxidil is currently used topically to treat androgenetic alopecia (male pattern baldness and female hair loss) and is cleared by the MHRA and the FDA for this purpose. Itsoral version is not licensed as a treatment forhair loss, although it can be used to treat hypertension.

Although minoxidil has only been approved and licensed for the treatment of hair loss due to genetic causes, for topical use it is, however, known to be effective in other cases such as Alopecia Areata, where only the scalp is affected.


The study

According to research published in the Journal of the American Academy of Dermatology and Healio Dermatology on September 18, 2019, participants in this study were12 adults, 7 women and 5 men.

The results obtained over a period of at least six months were analyzed.

Each was assigned a scores related to the severity of Alopecia that could be compared with other scores obtained during the study.

Initial levels of hair loss were recorded with average score of 99.5% in all study participants, meaning that they were all almost completely calvaried.


The results

The researchers reported the following results:

8 of the 12 patients achieved75% hair growth on the scalp, represented by a SALT score of 75;
4 of the 12 patients received a SALT score between 11 and 74, meaning they saw improvements in hair growth on the scalp between 11 and 74 %

Initially, all male patients were given a 5 mg tablet of Xeljanz once daily and 2.5 mg of minoxidil orally twice daily to minimize the potential risk of hypertrichosis: the development of excessive or unusual hair growth, such as facial hair.

However, of the eight patients observed to achieve a SALT of 75, the first seven used 5 mg of tofacitinib (Xeljanz) twice daily, while the eighth increased his dose of Xeljanz to 10 mg twice daily, after having no response to treatment with 5 mg twice daily over a 4- to 6-month period.

According to Dr. Carlos G. Wambier, of the Department of Dermatology at Yale and part of the team led by Dr. Brett King, “a patient who had seen no hair growth through the use of 11 mg of extended-release tofacitinib once daily for 3 months instead experienced significant hair growth during the first 3 months of combination therapy with tofacitinib and minoxidil.”

Janus kinase inhibitors are emerging as an important therapy for severe alopecia areata, due in part to the ability to improve efficacy without increasing inhibitor dosage and, along with it, immunomodulation and treatment cost.”


Xeljanz – the side effects

The prohibitive costs of the drugXeljanz have always been a concern, ever since JAK inhibitors were first considered as possible treatments for alopecia areata.

Another concern, which may explain why the Yale team attempted to combine a JAK inhibitor with another hair growth drug, was the current profile of side effects of Xeljanz.

Topical versions of the drug were tested separately to try to reduce the likelihood of its serious side effects, ranging from headaches touberculosis to upper respiratory and urinary tract infections to increased risk of tuberculosis.


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