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Mahajan A, Sharma G, Thakur A, Singh B, Mehta H, Mittal N, Dogra S, Katare OP. Tofacitinib in dermatology: a potential opportunity for topical applicability through novel drug-delivery systems. Nanomedicine (Lond) 2024; 19:79-101. [PMID: 38197372 DOI: 10.2217/nnm-2023-0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
Tofacitinib is a first-generation JAK inhibitor approved by the US FDA for treating rheumatoid arthritis. It exhibits a broad-spectrum inhibitory effect with abilities to block JAK-STAT signalling. The primary objective of this review is to obtain knowledge about cutting-edge methods for effectively treating a variety of skin problems by including tofacitinib into formulations that are based on nanocarriers. The review also highlights clinical trials and offers an update on published clinical patents. Nanocarriers provide superior performance compared to conventional treatments in terms of efficacy, stability, drug bioavailability, target selectivity and sustained drug release. Current review has the potential to make significant contributions to the ongoing discussion involving dermatological treatments and the prospective impact of nanotechnology on transforming healthcare within this field.
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Affiliation(s)
- Akanksha Mahajan
- University Institute of Pharmaceutical Sciences, UGC-centre of Advanced Studies, Panjab University, Chandigarh, 160014, India
| | - Gajanand Sharma
- University Institute of Pharmaceutical Sciences, UGC-centre of Advanced Studies, Panjab University, Chandigarh, 160014, India
| | - Anil Thakur
- University Institute of Pharmaceutical Sciences, UGC-centre of Advanced Studies, Panjab University, Chandigarh, 160014, India
| | - Bhupinder Singh
- University Institute of Pharmaceutical Sciences, UGC-centre of Advanced Studies, Panjab University, Chandigarh, 160014, India
- Chitkara College of Pharmacy, Chitkara University, Punjab, 140401, India
| | - Hitaishi Mehta
- Department of Dermatology, Venereology & Leprology, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, 160012, India
| | - Neeraj Mittal
- Chitkara College of Pharmacy, Chitkara University, Punjab, 140401, India
| | - Sunil Dogra
- Department of Dermatology, Venereology & Leprology, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, 160012, India
| | - O P Katare
- University Institute of Pharmaceutical Sciences, UGC-centre of Advanced Studies, Panjab University, Chandigarh, 160014, India
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Corbella-Bagot L, Riquelme-McLoughlin C, Morgado-Carrasco D. Long-Term Safety Profile and Off-Label Use of JAK Inhibitors in Dermatological Disorders. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T784-T801. [PMID: 37543140 DOI: 10.1016/j.ad.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/12/2023] [Indexed: 08/07/2023] Open
Abstract
JAK inhibitors target specific inflammatory cytokines involved in various inflammatory diseases. Four molecules have been approved for dermatological use: upadacitinib, baricitinib, abrocitinib and topical ruxolitinib. Off-label prescriptions for other dermatological conditions have been reported. We conducted a narrative review of the literature to assess the long-term safety profile of currently approved JAK inhibitors in dermatology, and their off-label use in skin disorders. We performed literature searches with PubMed and Google Scholar from January 2000 to January 2023, using the keywords "Janus kinase inhibitors", "JAK inhibitors","off-label", "dermatology", "safety", "adverse events", "ruxolitinib", "upadacitinib","abrocitinib" and "baricitinib". Our search yielded a total of 37 dermatological disorders with studies supporting the use of these JAK inhibitors. Preliminary studies indicate that JAK inhibitors generally have a favorable safety profile and can be considered as an option in many dermatological disorders.
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Affiliation(s)
- L Corbella-Bagot
- Departamento de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - C Riquelme-McLoughlin
- Departamento de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - D Morgado-Carrasco
- Departamento de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España; Departamento de Dermatología, Hospital de Figueres, Fundació Salut Empordà, Figueres, España.
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Corbella-Bagot L, Riquelme-McLoughlin C, Morgado-Carrasco D. Long-Term Safety Profile and Off-Label Use of JAK Inhibitors in Dermatological Disorders. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:784-801. [PMID: 37331618 DOI: 10.1016/j.ad.2023.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/05/2023] [Accepted: 06/12/2023] [Indexed: 06/20/2023] Open
Abstract
JAK inhibitors target specific inflammatory cytokines involved in various inflammatory diseases. Four molecules have been approved for dermatological use: upadacitinib, baricitinib, abrocitinib and topical ruxolitinib. Off-label prescriptions for other dermatological conditions have been reported. We conducted a narrative review of the literature to assess the long-term safety profile of currently approved JAK inhibitors in dermatology, and their off-label use in skin disorders. We performed literature searches with Pubmed and Google Scholar from January 2000 to January 2023, using the keywords "Janus kinase inhibitors", "JAK inhibitors", "off-label", "dermatology", "safety", "adverse events", "ruxolitinib", "upadacitinib", "abrocitinib" and "baricitinib". Our search yielded a total of 37 dermatological disorders with studies supporting the use of these JAK inhibitors. Preliminary studies indicate that JAK inhibitors generally have a favorable safety profile and can be considered as an option in many dermatological disorders.
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Affiliation(s)
- L Corbella-Bagot
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
| | - C Riquelme-McLoughlin
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
| | - D Morgado-Carrasco
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain; Department of Dermatology, Hospital de Figueres, Fundació Salut Empordà, Figueres, Spain.
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Dogra S, Sharma A, Mehta H, Sarkar R. Emerging role of topical Janus kinase inhibitors in dermatological disorders: a review. Clin Exp Dermatol 2023; 48:1102-1112. [PMID: 37235767 DOI: 10.1093/ced/llad188] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/05/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
Janus kinase (JAK) refers to a family of tyrosine kinases that are involved in the production of proinflammatory mediators in response to various extracellular signals. The JAK-signal transducer and activator of transcription (STAT) pathway is an appealing target in many inflammatory illnesses as this pathway modulates immune cell activation and T-cell-mediated inflammation in response to several cytokines. The practical considerations of prescription for topical and oral JAK inhibitors (JAKis) in atopic dermatitis, vitiligo and psoriasis have been covered in prior publications. Currently, the US Food and Drug Administration has approved the topical JAKi ruxolitinib for atopic dermatitis and nonsegmental vitiligo. None of the remaining first- or second-generation topical JAKis have been approved for topical application in any dermatological indications so far. For this review, the PubMed database was searched using 'topical' and 'JAK inhibitor' or 'Janus kinase inhibitor' or the names of individual drug molecules as the keyword in the title with no date limits. The description of topical JAKi usage in dermatology from the literature was evaluated in each abstract. The current review concentrates on emphasizing the rising use of topical JAKis in both approved and off-label dermatological applications for both old and novel conditions.
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Affiliation(s)
- Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Apoorva Sharma
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Hitaishi Mehta
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rashmi Sarkar
- Department of Dermatology, Lady Hardinge Medical College and associated Hospitals, New Delhi, India
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Mattsson J, Israelsson E, Björhall K, Yrlid LF, Thörn K, Thorén A, Toledo EA, Jinton L, Öberg L, Wingren C, Tapani S, Jackson SG, Skogberg G, Lundqvist AJ, Hendrickx R, Cavallin A, Österlund T, Grimster NP, Nilsson M, Åstrand A. Selective Janus kinase 1 inhibition resolves inflammation and restores hair growth offering a viable treatment option for alopecia areata. SKIN HEALTH AND DISEASE 2023. [DOI: 10.1002/ski2.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Johan Mattsson
- Bioscience, Research and Early Development Respiratory & Immunology (R&I) BioPharmaceuticals R&D AstraZeneca Gothenburg Sweden
| | - Elisabeth Israelsson
- Translational Science and Experimental Medicine Research and Early Development Respiratory & Immunology (R&I) BioPharmaceuticals R&D AstraZeneca Gothenburg Sweden
| | - Karin Björhall
- Bioscience, Research and Early Development Respiratory & Immunology (R&I) BioPharmaceuticals R&D AstraZeneca Gothenburg Sweden
| | - Linda Fahlén Yrlid
- Bioscience, Research and Early Development Respiratory & Immunology (R&I) BioPharmaceuticals R&D AstraZeneca Gothenburg Sweden
| | - Kristoffer Thörn
- Translational Science and Experimental Medicine Research and Early Development Respiratory & Immunology (R&I) BioPharmaceuticals R&D AstraZeneca Gothenburg Sweden
| | - Anna Thorén
- Animal Science and Technologies Clinical Pharmacology & Safety Sciences BioPharmaceuticals R&D AstraZeneca Gothenburg Sweden
| | - Emelie Andersén Toledo
- Animal Science and Technologies Clinical Pharmacology & Safety Sciences BioPharmaceuticals R&D AstraZeneca Gothenburg Sweden
| | - Lisa Jinton
- Bioscience, Research and Early Development Respiratory & Immunology (R&I) BioPharmaceuticals R&D AstraZeneca Gothenburg Sweden
| | - Lisa Öberg
- Translational Science and Experimental Medicine Research and Early Development Respiratory & Immunology (R&I) BioPharmaceuticals R&D AstraZeneca Gothenburg Sweden
| | - Cecilia Wingren
- Bioscience, Research and Early Development Respiratory & Immunology (R&I) BioPharmaceuticals R&D AstraZeneca Gothenburg Sweden
| | - Sofia Tapani
- Early Biometrics & Statistical Innovation Data Science & AI BioPharmaceuticals R&D AstraZeneca Gothenburg Sweden
| | - Sonya G. Jackson
- Bioscience, Research and Early Development Respiratory & Immunology (R&I) BioPharmaceuticals R&D AstraZeneca Gothenburg Sweden
| | - Gabriel Skogberg
- Bioscience, Research and Early Development Respiratory & Immunology (R&I) BioPharmaceuticals R&D AstraZeneca Gothenburg Sweden
| | - Anders J. Lundqvist
- Drug Metabolism & Pharmacokinetics Research and Early Development Respiratory & Immunology (R&I) BioPharmaceuticals R&D AstraZeneca Gothenburg Sweden
| | - Ramon Hendrickx
- Drug Metabolism & Pharmacokinetics Research and Early Development Respiratory & Immunology (R&I) BioPharmaceuticals R&D AstraZeneca Gothenburg Sweden
| | - Anders Cavallin
- Bioscience, Research and Early Development Respiratory & Immunology (R&I) BioPharmaceuticals R&D AstraZeneca Gothenburg Sweden
| | - Torben Österlund
- The Discovery Sciences Unit BioPharmaceuticals R&D AstraZeneca Gothenburg Sweden
| | | | - Magnus Nilsson
- Medicinal Chemistry BioPharmaceuticals R&D AstraZeneca Gothenburg Sweden
| | - Annika Åstrand
- Bioscience, Research and Early Development Respiratory & Immunology (R&I) BioPharmaceuticals R&D AstraZeneca Gothenburg Sweden
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Barati Sedeh F, Michaelsdóttir TE, Henning MAS, Jemec GBE, Ibler KS. Comparative Efficacy and Safety of Janus Kinase Inhibitors Used in Alopecia Areata: A Systematic Review and Meta-analysis. Acta Derm Venereol 2023; 103:adv00855. [PMID: 36695751 PMCID: PMC10391778 DOI: 10.2340/actadv.v103.4536] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/29/2022] [Indexed: 01/26/2023] Open
Abstract
The aim of this study was to compare the efficacy and safety of treatment with Janus kinase inhibitors for alopecia areata, measured by change in Severity of Alopecia Tool (SALT) score. A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was performed using Medline, EMBASE and Cochrane library. All studies investigating the efficacy of treatments for alopecia areata were included. Primary outcomes were the proportion of patients with alopecia areata achieving 30%, 50%, 75%, 90% and 100% improvement in SALT score after treatment with a Janus kinase inhibitor. A meta-analysis was performed including all randomized controlled trials investigating Janus kinase inhibitors. A total of 37 studies matched the inclusion criteria and were included. Meta-analysis was performed based on 5 randomized studies. Regarding patients with alopecia areata defined as ≥ 50% scalp hair loss, baricitinib 4 mg once daily demonstrated the highest efficacy. However, among patients with alopecia areata defined as a SALT score ≥ 50, oral deuruxolitinib 12 mg twice daily demonstrated the highest efficacy. Deuruxolitinib and baricitinib appear to be promising drugs for the treatment of alopecia areata. However, the response depends on the dosage of the drug. More randomized trials, with identical inclusion criteria and dose and duration of treatment, are required to confirm these findings.
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Dillon KAL. A Comprehensive Literature Review of JAK Inhibitors in Treatment of Alopecia Areata. Clin Cosmet Investig Dermatol 2021; 14:691-714. [PMID: 34211288 PMCID: PMC8242127 DOI: 10.2147/ccid.s309215] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/28/2021] [Indexed: 12/13/2022]
Abstract
Alopecia areata (AA) is a chronic, immune-mediated form of nonscarring alopecia that is multifactorial and results in localized patches. It is often described as a self-limiting condition that results in the spontaneous regrowth of hair in most cases. However, this regrowth may take several months or years to occur in some patients, leading to the development of psychoemotional trauma in those that are affected. Although several therapies for AA have been developed and tested, there is no specific treatment that has been approved, leading to the availability of many off-label conventional treatment options, with very limited responses. More recently, with the advancement of pre-clinical and genetic studies, a greater understanding of the pathomechanisms involved in the development of AA has been uncovered. This has resulted in the introduction of targeted therapies that use small molecules to block specific pathways involved in AA pathophysiology. As such, the use of janus kinase (JAK) inhibitors for treatment of AA has emerged. JAK inhibitors block the T-cell mediated inflammatory response thought to be the driving factor behind AA pathogenesis, by inhibiting the janus kinase (JAK) signal transducer and activator of transcription (STAT) signaling pathway, leading to a reversal of hair loss in AA patients. Thus, in an effort to demonstrate the efficacy of JAK inhibitors in the treatment of AA, several studies have been published within recent years. However, the question remains, “Are JAK inhibitors effective and safe in the management of Alopecia Areata?”. This review aims to provide a comprehensive report on the role, efficacy, and outcomes of using JAK inhibitors in the treatment of AA. To competently answer the research question highlighted, the most recent, quality articles published over a 10–15-year period were sourced using PubMed, NCBI, Research gate, Medline, Cochrane Central Register of Controlled Trials, EMBASE and Google scholar. The literature search was primarily focused on randomized controlled trials (RCTs); however, in the absence of such, only the most recently published case reports, case series, clinical trials and open-label studies published to date were included.
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Affiliation(s)
- Kerry-Ann L Dillon
- Department of Microbiology, Immunology and Pharmacology, St. George's University School of Medicine, True Blue, Grenada.,Department of Dermatology, School of Health, Sport & Professional Practice, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, South Wales, UK
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8
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Garcia-Melendo C, Cubiró X, Puig L. Janus Kinase Inhibitors in Dermatology: Part 1 — General Considerations and Applications in Vitiligo and Alopecia Areata. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2021.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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9
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Inhibidores de JAK: usos en dermatología. Parte 1: generalidades, aplicaciones en vitíligo y en alopecia areata. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.ad.2020.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Zheng C, Tosti A. Alopecia Areata: New Treatment Options Including Janus Kinase Inhibitors. Dermatol Clin 2021; 39:407-415. [PMID: 34053594 DOI: 10.1016/j.det.2021.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Alopecia areata (AA) is a chronic, relapsing, autoimmune disorder characterized by patchy nonscaring hair loss. Although the pathogenesis of alopecia areata is not yet completely elucidated, loss of immune privilege in anagen stage hair follicles is widely accepted to play a key role. Several cytokines that depend on Janus kinase signaling have been identified to be involved in AA, including interleukin (IL)-2, IL-7, IL-15, IL-21, and interferon-γ, making Janus kinase inhibitors an attractive therapeutic target. Available information indicates that about 70% of patients with AA experience significant regrowth, but interruption of treatment is associated with disease recurrence.
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Affiliation(s)
- Caiwei Zheng
- University of Miami Miller School of Medicine, 1150 Northwest 14th Street, Miami, FL 33136, USA
| | - Antonella Tosti
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1150 Northwest 14th Street, Miami, FL 33136, USA.
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Abstract
PURPOSE Ruxolitinib (Jakafi) is a Janus kinase 1 and 2 small molecule inhibitor that the Food and Drug Administration approved for myelofibrosis and polycythemia vera. It has been expanded to off-label treatment for a variety of dermatologic conditions, with several clinical trials ongoing. A review of available studies and cases of off-label uses was performed to guide clinicians seeking evidence on the efficacy of this Janus kinase inhibitor for dermatologic disorders. MATERIALS AND METHODS PubMed/MEDLINE, EMBASE, Scopus, and ClinicalTrials.gov databases were searched with the term "ruxolitinib," and results were manually reviewed to identify published data on off-label uses of ruxolitinib. Studies included are structured by quality of evidence available. RESULTS Ruxolitinib may have utility in the treatment of atopic dermatitis, psoriasis, and vitiligo, with data from open-label and randomized trials supporting efficacy of topical formulations. Evidence of utility for alopecia areata is mixed and differs depending on topical versus oral form. Evidence for numerous other conditions is available through case reports and case series. CONCLUSIONS There is growing evidence supporting potential off-label use of oral and topical ruxolitinib for a wide range of skin conditions. There are several ongoing investigations of ruxolitinib use in dermatology that will undoubtedly better define its efficacy and appropriate use in dermatology.
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Abstract
Ruxolitinib is a Janus kinase (JAK) inhibitor that is FDA-approved for the treatment of myelofibrosis, polycythemia vera, and acute graft-versus-host disease. Its use in treating various dermatologic diseases has been a topic of growing interest due to its favorable safety profile and targeted inhibition of several cytokines that perpetuate inflammatory skin conditions. The PubMed/MEDLINE and ClinicalTrials.gov databases were searched for literature on off-label uses of ruxolitinib in dermatology and ongoing trials studying its safety and efficacy. There is randomized controlled trial (RCT) evidence for the successful use of ruxolitinib in treating alopecia, atopic dermatitis, and psoriasis, with ongoing RCTs for its use in vitiligo. Smaller studies have confirmed the success of ruxolitinib in treating conditions such as dermatomyositis and hypereosinophilic syndrome, among others. No serious adverse effects were reported with the use of ruxolitinib in dermatology, but further research is needed to determine its efficacy, delivery route, and optimal dosing for treating dermatologic conditions.
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Affiliation(s)
- Jessica Wu
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Jan Smogorzewski
- Division of Dermatology, Harbor-UCLA Medical Center, Torrance, CA, USA
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Fragoulis GE, McInnes IB, Siebert S. JAK-inhibitors. New players in the field of immune-mediated diseases, beyond rheumatoid arthritis. Rheumatology (Oxford) 2020; 58:i43-i54. [PMID: 30806709 PMCID: PMC6390879 DOI: 10.1093/rheumatology/key276] [Citation(s) in RCA: 208] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 08/03/2018] [Indexed: 02/06/2023] Open
Abstract
Janus kinase (JAK)/signal transducers and activators of transcription (STATs) are a group of molecules associated with one of the major pathways through which many cytokines exert and integrate their function, and as such they are increasingly recognized as playing critical role in the pathogenesis subserving various immune-mediated diseases, including RA, PsA, SpAs, IBD, skin disorders (e.g. alopecia areata, atopic dermatitis), single-gene disorders like interferonopathies, and others. JAKs are the key initiating players of the JAK/STAT pathway. Upon binding of their respective effector molecules (cytokines, IFNs, growth factors and others) to type I and type II receptors, JAKs are activated, and through phosphorylation of themselves and of other molecules (including STATs), they mediate signal transduction to the nucleus. A class of drugs—called JAK inhibitors or JAKinibs—that block one or more JAKs has been developed in the last decade, and now numbers >20 members. Although, so far, JAK inhibitors have been marketed only for RA and PsA, these drugs have been tested in phase 2 and phase 3 clinical trials for other inflammatory conditions and beyond. In this review, we summarize the clinical data, including efficacy and safety, available for JAK inhibitors used in some immune-mediated conditions other than RA.
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Affiliation(s)
- George E Fragoulis
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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Ismail FF, Sinclair R. JAK inhibition in the treatment of alopecia areata – a promising new dawn? Expert Rev Clin Pharmacol 2019; 13:43-51. [DOI: 10.1080/17512433.2020.1702878] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
| | - Rodney Sinclair
- Sinclair Dermatology, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
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Montilla AM, Gómez-García F, Gómez-Arias PJ, Gay-Mimbrera J, Hernández-Parada J, Isla-Tejera B, Ruano J. Scoping Review on the Use of Drugs Targeting JAK/STAT Pathway in Atopic Dermatitis, Vitiligo, and Alopecia Areata. Dermatol Ther (Heidelb) 2019; 9:655-683. [PMID: 31606872 PMCID: PMC6828894 DOI: 10.1007/s13555-019-00329-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The JAK/STAT signaling pathway is involved in the immune-mediated inflammatory skin diseases atopic dermatitis (AD), vitiligo, and alopecia areata (AA), and represents a potential target when developing treatments. So far, no drugs targeting this pathway have been approved for the treatment of dermatological diseases. We reviewed the use of drugs blocking the JAK/STAT pathway in the aforementioned diseases. METHODS An a priori protocol was published. We used Joanna Briggs Institute Reviewer's Manual methodology to conduct the review and PRISMA Extension for Scoping Review (PRISMA-ScR) to report results. MEDLINE, EMBASE, CINAHL, Scopus, and Web of Science databases were searched in a three-step approach on April 2019 by two researchers. RESULTS Ninety-six mainly multicenter observational studies were included (66, 10, and 20 studies on AA, vitiligo, and AD, respectively). Tofacitinib and ruxolitinib were mainly used for the three diseases, and also upadacitinib, abrocitinib, baricitinib, cerdulatinib, delgocitinib, gusacitinib for AD, and baricitinib, PF-06700841, and PF-06651600 for AA. All patients with AD improved, whereas patients with vitiligo and patients with AA showed varied responses, including unresponsive cases. The safety profiles were similar for all drugs and diseases, mainly comprising mild or no adverse events. CONCLUSIONS Evidence on the efficacy and safety of drugs targeting the JAK/STAT pathway for the treatment of patients with AD, vitiligo, or AA is increasing but is still of low quality.
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Affiliation(s)
- Ana M Montilla
- Immune-mediated Inflammatory Skin Diseases Group, IMIBIC/Reina Sofía University Hospital/University of Córdoba, 14004, Córdoba, Spain
- School of Medicine, University of Córdoba, 14004, Córdoba, Spain
| | - Francisco Gómez-García
- Immune-mediated Inflammatory Skin Diseases Group, IMIBIC/Reina Sofía University Hospital/University of Córdoba, 14004, Córdoba, Spain
- Department of Dermatology, Reina Sofía University Hospital, 14004, Córdoba, Spain
| | - Pedro J Gómez-Arias
- Immune-mediated Inflammatory Skin Diseases Group, IMIBIC/Reina Sofía University Hospital/University of Córdoba, 14004, Córdoba, Spain
- Department of Dermatology, Reina Sofía University Hospital, 14004, Córdoba, Spain
| | - Jesús Gay-Mimbrera
- Immune-mediated Inflammatory Skin Diseases Group, IMIBIC/Reina Sofía University Hospital/University of Córdoba, 14004, Córdoba, Spain
| | | | - Beatriz Isla-Tejera
- Immune-mediated Inflammatory Skin Diseases Group, IMIBIC/Reina Sofía University Hospital/University of Córdoba, 14004, Córdoba, Spain
- Department of Pharmacy, Reina Sofía University Hospital, 14004, Córdoba, Spain
| | - Juan Ruano
- Immune-mediated Inflammatory Skin Diseases Group, IMIBIC/Reina Sofía University Hospital/University of Córdoba, 14004, Córdoba, Spain.
- Department of Dermatology, Reina Sofía University Hospital, 14004, Córdoba, Spain.
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Lee S, Kim BJ, Lee YB, Lee WS. Hair Regrowth Outcomes of Contact Immunotherapy for Patients With Alopecia Areata: A Systematic Review and Meta-analysis. JAMA Dermatol 2019; 154:1145-1151. [PMID: 30073292 DOI: 10.1001/jamadermatol.2018.2312] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Importance Contact immunotherapy with diphenylcyclopropenone or squaric acid dibutyl ester is a preferred treatment for severe alopecia areata; however, the defined criteria for therapeutic hair regrowth and regrowth rate have been highly heterogeneous across studies. Objective To summarize the clinical outcomes of contact immunotherapy for alopecia areata according to standardized criteria for therapeutic hair regrowth and several prognostic factors. Data Source A database search of MEDLINE, Embase, and Cochrane Library was performed for articles published before November 20, 2017, using the search terms areata, totalis, universalis, sensitizer, sensitization, immunotherapy, DPCP, diphenylcyclopropenone, diphencyprone, SADBE, and squaric. Study Selection Clinical trials or observational studies that investigated contact immunotherapy for alopecia areata and subgrouped the disease into patchy alopecia or alopecia totalis/universalis and reported their hair regrowth rates were included, whereas studies that investigated combination therapy or nonconventional protocol and case series or reviews were excluded. Data Extraction and Synthesis The following data were extracted from each of the studies included in this meta-analysis: study year and setting, sensitizer type, study population, study population composition by disease subtype, defined criteria for therapeutic hair regrowth, and regrowth rate of contact immunotherapy. The incidence of adverse effects and recurrence rate were also recorded. A random effects model was used for data synthesis because of the expected high heterogeneity of the included studies. Main Outcomes and Measures The main outcome was therapeutic hair regrowth rate according to the 4-grade criteria for therapeutic regrowth. Secondary outcomes included incidence of treatment-related adverse effects and recurrence rate. Results Forty-five studies comprising 2227 patients were analyzed. The overall rate of any hair regrowth was 65.5% among patients with alopecia areata (74.6% in the patchy alopecia and 54.5% in the alopecia totalis/universalis subgroups). However, the complete regrowth rate was 32.3% (24.9% in the patchy alopecia and 32.3% in the alopecia totalis/universalis subgroups). Disease extent of 50% or greater (odds ratio [OR], 3.05; 95% CI, 2.26-4.12), atopic history (OR, 1.61; 95% CI, 1.03-2.50), and nail involvement (OR, 2.06; 95% CI. 1.26-3.36) were associated with poorer therapeutic outcome. Recurrence rates were 38.3% among patients receiving maintenance treatment and 49.0% among those not receiving maintenance treatment. Conclusions and Relevance Various factors were associated with the clinical outcomes of contact immunotherapy for alopecia areata, with significant differences in hair regrowth rates according to the level of expected therapeutic regrowth. Quantitative summarization may improve patient education and lead to better therapeutic adherence and outcomes.
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Affiliation(s)
- Solam Lee
- Institute of Hair and Cosmetic Medicine, Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Beom Jun Kim
- Institute of Hair and Cosmetic Medicine, Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Young Bin Lee
- Institute of Hair and Cosmetic Medicine, Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Won-Soo Lee
- Institute of Hair and Cosmetic Medicine, Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
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17
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de Oliveira AB, Alpalhão M, Filipe P, Maia-Silva J. The role of Janus kinase inhibitors in the treatment of alopecia areata: A systematic review. Dermatol Ther 2019; 32:e13053. [PMID: 31381252 DOI: 10.1111/dth.13053] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 12/18/2022]
Abstract
Alopecia areata (AA) is a non-scarring alopecia, which often carries a major impact on patients' quality of life. Currently there is no single approved treatment that effectively induces permanent remission. Recently, the JAK-STAT signaling pathway has emerged as a possible therapeutic target leading to increased interest in the use of Janus kinase (JAK) inhibitors (JAKis) in the treatment of this pathology. This review of the literature summarizes information on patients with AA who underwent treatment with JAKis and discusses the current evidence on the efficacy and safety of its use. A literature search was conducted in different databases to identify clinical trials and case reports published in January 2019. Several clinical studies have shown very promising results in the treatment of AA with oral formulas of JAKis. These agents, however, need chronic administration to maintain response. Topical formulations did not show satisfactory responses. The safety profile of these agents appears to be favorable. Current evidence is promising regarding the efficacy and safety of oral JAKis. However, the data obtained are of low quality, originating predominantly from reports of clinical cases. Further studies are needed to confirm these data and to optimize its long-term efficacy and safety.
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Affiliation(s)
| | - Miguel Alpalhão
- Dermatology and Venereology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.,Dermatology Investigation Unit, Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal
| | - Paulo Filipe
- Dermatology and Venereology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.,Dermatology Investigation Unit, Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal.,Universitary Clinic of Dermatology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - João Maia-Silva
- Dermatology and Venereology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.,Dermatology Investigation Unit, Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal.,Universitary Clinic of Dermatology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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18
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Abstract
The treatment of hair loss is a challenge for all dermatologists. New medications are needed due to lack of efficacy of many treatments or their side-effect profile. This article discusses the most recent literature updates on the use of retinoids in frontal fibrosing alopecia, platelet-rich plasma in androgenetic alopecia, and JAK inhibitors in alopecia areata.
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Affiliation(s)
- Leopoldo Duailibe Nogueira Santos
- Santa Casa of São Paulo School of Medicine, Rua Doutor Cesário Motta Júnior 61, São Paulo, SP 01221-020, Brazil; Municipal Public Servant Hospital of São Paulo, Rua Castro Alves 60, São Paulo, SP 01532-000, Brazil; University of Taubaté, Av. Granadeiro Guimarães 270, Taubaté, SP 12020-130, Brazil; The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 530 First Avenue, Suite 7R, New York, NY 10016, USA
| | - Jerry Shapiro
- Municipal Public Servant Hospital of São Paulo, Rua Castro Alves 60, São Paulo, SP 01532-000, Brazil.
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19
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[Postmenopausal lichen planopilaris also known as fibrosing frontotemporal alopecia Kossard : An evidence-oriented practical guide to treatment from the University of the Saarland, Hair Research Center of the Dr. Rolf M. Schwiete Foundation]. Hautarzt 2019; 69:134-142. [PMID: 29362834 DOI: 10.1007/s00105-017-4118-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Postmenopausal lichen planopilaris (PLPP), also known as fibrosing frontotemporal alopecia Kossard (FFAK), is a not uncommon inflammatory scalp disease affecting approximately 5% of patients at specialized hair centers. The overall incidence of sporadic occurrence is believed to be just under 1% in the older, predominantly female, general population. Since the disease is often undiagnosed, it is statistically likely to be underrepresented. It especially occurs in postmenopausal women who are in the 6th and 7th decade of life (90%), but also in about 10% of premenopausal women, and in men it is documented only in isolated cases. The result is a permanent scarring hair loss accentuated at the front hairline with backward movement towards the neck mostly accompanied by a typical loss of the eyebrows. The disease therefore often leads to significant mental distress and social anxiety in those affected. This is the basis for a compelling need to develop evidence-based therapeutic concepts. While numerous retrospective case series have characterized the phenomenology of FFAK very well, to date there are no randomized controlled trials on evidence-based therapy. Here, we present the Homburger Evidence-Oriented Therapy Algorithm, which is oriented along the available case series evidence: It may (1) serve as a therapy guide for practice and (2) can be used as a basis for working out reliable data based on study evidence. The article contains detailed practical information on photo documentation, biopsy and histological processing up to the practical implementation of, for example, intralesional steroid therapy as well as information on selection criteria for suitable systemic therapies.
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20
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Phan K, Sebaratnam DF. JAK inhibitors for alopecia areata: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2019; 33:850-856. [PMID: 30762909 DOI: 10.1111/jdv.15489] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/18/2019] [Indexed: 12/14/2022]
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 difference 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.
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Affiliation(s)
- K Phan
- Department of Dermatology, Liverpool Hospital, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - D F Sebaratnam
- Department of Dermatology, Liverpool Hospital, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Departments of Dermatology, Sydney Children's Hospitals' Network, Sydney, NSW, Australia
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21
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Abstract
Atopic dermatitis (AD) is one of the most common inflammatory skin diseases. AD is driven by barrier dysfunction and abnormal immune activation of T helper (Th) 2, Th22, and varying degrees of Th1 and Th17 among various subtypes. The Janus kinase (JAK)-signal transducer and activator of transcription (STAT) and spleen tyrosine kinase (SYK) pathways are involved in signaling of several AD-related cytokines, such as IFN-γ, IL-4, IL-13, IL-31, IL-33, IL-23, IL-22, and IL-17, mediating downstream inflammation and barrier alterations. While AD is primarily Th2-driven, the clinical and molecular heterogeneity of AD endotypes highlights the unmet need for effective therapeutic options that target more than one immune axis and are safe for long-term use. The JAK inhibitors, which target different combinations of kinases, have overlapping but distinct mechanisms of action and safety profiles. Several topical and oral JAK inhibitors have been shown to decrease AD severity and symptoms. A review of the JAK and SYK inhibitors that are currently undergoing evaluation for efficacy and safety in the treatment of AD summarizes available data on a promising area of therapeutics and further elucidates the complex molecular interactions that drive AD.
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Affiliation(s)
- Helen He
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, 5 E. 98th Street, New York, NY, 10029, USA
| | - Emma Guttman-Yassky
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, 5 E. 98th Street, New York, NY, 10029, USA.
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA.
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22
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Crowley EL, Fine SC, Katipunan KK, Gooderham MJ. The Use of Janus Kinase Inhibitors in Alopecia Areata: A Review of the Literature. J Cutan Med Surg 2019; 23:289-297. [DOI: 10.1177/1203475418824079] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Alopecia areata (AA) is a chronic, immune-mediated disorder that targets hair follicle epithelium, thereby restricting hair growth in localized patches. Although several therapies for AA have been tested, responses with traditional therapies have been limited. In recent years, numerous reports have been published of patients with AA responding to Janus kinase (JAK) inhibitors. This literature review aims to describe AA pathophysiology, explore how and why JAK inhibitors can be used for AA treatment, and review published case reports, case series, and open-label studies published to date. Pathogenesis of AA includes interactions between genetic, environmental, and immune factors and is mediated by the cytokines interferon-γ and interleukin (IL)-15. JAK inhibition resulting in hair regrowth in some cases supports that AA is associated with the Janus kinase-signal transducer and activator of transcription (JAK-STAT) signaling pathway. The emergence of JAK inhibitors for AA therapy is changing the way health care providers think about and treat AA. A mixture of animal model studies and human case studies have reported the use of baricitinib (JAK 1/2), ruxolitinib (JAK 1/2), and tofacitinib (JAK 1/3) for the management of AA. JAK inhibition has shown potential as an effective AA therapy when used in case studies, case series, and open-label trials. Formal clinical trials are ongoing and will yield more definitive conclusions about the safety and efficacy of JAK inhibitors.
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Affiliation(s)
- Erika L. Crowley
- SKiN Centre for Dermatology, Peterborough, ON, Canada
- Trent University, Peterborough, ON, Canada
| | - Shamone C. Fine
- SKiN Centre for Dermatology, Peterborough, ON, Canada
- Trent University, Peterborough, ON, Canada
| | - Kathleen Kwan Katipunan
- SKiN Centre for Dermatology, Peterborough, ON, Canada
- Probity Medical Research, Waterloo, ON, Canada
| | - Melinda J. Gooderham
- SKiN Centre for Dermatology, Peterborough, ON, Canada
- Probity Medical Research, Waterloo, ON, Canada
- Queen’s University, Kingston, ON, Canada
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23
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Topical Janus kinase inhibitors: A review of applications in dermatology. J Am Acad Dermatol 2018; 79:535-544. [DOI: 10.1016/j.jaad.2018.04.018] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/28/2018] [Accepted: 04/05/2018] [Indexed: 02/06/2023]
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24
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Triyangkulsri K, Suchonwanit P. Role of janus kinase inhibitors in the treatment of alopecia areata. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:2323-2335. [PMID: 30100707 PMCID: PMC6067625 DOI: 10.2147/dddt.s172638] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Alopecia areata (AA) is a common hair loss disorder worldwide with characteristic exclamation mark hairs. Although AA is self-limited, it can last for several months or even years in some patients. Currently, there is no US Food and Drug Administration-approved treatment for AA. Many off-label treatments are available but with limited efficacy. Through a better understanding of molecular biology, many targeted therapies have emerged as new alternatives for various autoimmune diseases. Various janus kinase (JAK) and signal transducer and activator of transcription (STAT) proteins form signaling pathways, which transmit extracellular cytokine signals to the nucleus and induce DNA transcriptions. By inhibiting JAK, T-cell-mediated inflammatory responses are suppressed. Increasing evidence suggests that JAK inhibitors (JAKis) are effective in the treatment of many autoimmune diseases, including AA. Among these, several studies on tofacitinib, ruxolitinib, and baricitinib in AA had been published, demonstrating promising outcomes of these agents. Unlike oral formulations, efficacy of topical forms of tofacitinib and ruxolitinib reported in these studies is still unsatisfactory and requires improvement. This review aims to summarize evidence of the efficacy and safety of JAKis in the treatment of AA.
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Affiliation(s)
- Korn Triyangkulsri
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,
| | - Poonkiat Suchonwanit
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,
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