Gut instinct: Using tofacitinib to treat alopecia areata in the context of comorbid inflammatory bowel disease

Abstract

AA: alopecia areata IBD: inflammatory bowel disease IL: interleukin JAK: Janus kinase UC: ulcerative colitis INTRODUCTION Alopecia areata (AA) is an autoimmune form of hair loss characterized by T-cell-mediated damage to hair follicles. Inflammatory bowel disease (IBD) is an autoimmune disease of the bowel characterized by dysregulation of T cells, increased production of proinflammatory cytokines (eg, interleukin [IL] 6, IL23, IL-12, and IL-21), and intestinal epithelial dysfunction. Genome-wide association studies, performed separately in AA and IBD populations, reveal overlapping susceptibility loci in AA and Crohn disease (PRDX5 and IL-2RA) and AA and ulcerative colitis (UC) (IL-2/IL-21). The incidence of comorbid AA and IBD is unknown. Despite the success of biologics for the treatment of IBD, it may be that some biologics, in particular tumor necrosis factor a inhibitors, precipitate AA. The Janus kinase (JAK) inhibitor tofacitinib is approved for the treatment of UC, and there are several ongoing trials of other JAK inhibitors for IBD. JAK inhibitors are an emerging treatment for AA. In this study, we describe the results of treatment of patients with comorbid IBD and AA with tofacitinib.