Study To Evaluate The Efficacy Of Tofacitinib In Moderate To Severe Alopecia Areata, Totalis And Universalis
Condition: Alopecia Areata
MeSH terms: Alopecia; Alopecia Areata
Study type: Interventional
Phase: Phase 2

Summary: 
      This is an open-label pilot study of tofacitinib taken daily for 6 months in the treatment of
      moderate to severe AA, and alopecia totalis or universalis, followed by 6 months follow-up
      off drug to assess the incidence and timing of recurrence of disease or documentation of
      delayed response to treatment. There will be the option of increasing the treatment duration
      up to an additional 6 months beyond the initially scheduled 6 months of treatment, if
      clinically indicated, and at the discretion of the investigator.
    

Detailed description: 
      Alopecia areata (AA) is a common disease of the immune system, known as an "autoimmune"
      disease. In the disease, the immune system mistakenly destroys the hair follicle, causing
      hair to fall out. Despite many people having this disease, research into its cause and new,
      better ways to treat AA has lagged far behind other similar diseases of the immune system.
      Currently, there are no Federal Drug Administration approved drugs for AA.

      Tofacitinib (made by Pfizer) is an intervention known to effectively treat a disease of the
      joints, known as rheumatoid arthritis. It is also being studied in the treatment of
      psoriasis, another "autoimmune" disease, by fighting inflammation. There are some genetic and
      chemical similarities between those with active rheumatoid arthritis, psoriasis, and
      AA,suggesting that treatment with the same drug is likely to be effective. In mice specially
      designed for testing drugs for the treatment of human alopecia, this medication worked to
      prevent the disease AA from starting in mice that would have otherwise developed the disease.
      To test Tofacitinib, we are going to treat 15 patients with moderate to severe AA for up to 6
      months. This is an "open label" study, meaning that there will not be a placebo group; all
      patients enrolled in the study will receive the active medication. The effectiveness of the
      medication will be measured by changes in hair re-growth as determined by physical exam and
      photography, as well as by patient and physician scoring. After the treatment period of up to
      6 months is completed, There will be the option of increasing the treatment duration up to an
      additional 6 months beyond the initially scheduled 6 months of treatment, if clinically
      indicated, and at the discretion of the investigator. Patients will be followed for another 6
      months off of the drug to see if the effects of treatment last and if there is delayed
      response. The safety of the medication, Tofacitinib, in patients with AA will also be
      evaluated. Blood work will be collected before medication is started, during the treatment
      period and after Tofacitinib is stopped in order to monitor for adverse effects of the
      medication. Small scalp biopsies and peripheral blood will be taken at the beginning of the
      study before treatment and at weeks 4 and 24. Additional, optional scalp biopsies and blood
      draws may be suggested at other important time points. The chemical analysis of these skin
      samples and blood will help us to understand how the disease happens, how the treatment
      works, and even guide us to better treatments in the future.
    

Intervention name(s): Tofacitinib
Intervention type(s): Drug
Intervention description(s): Dosage/Frequency: 5mg - 10mg, oral, twice daily
Other intervention name(s): XELJANZ
Intervention MeSH terms: Tofacitinib
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Alopecia Areata