Topical JAK Inhibitors for AA: Australian Placebo Controlled Study

Australian Placebo Controlled Study

JAK inhibitors like tofacitinib and ruxolitinib have shown benefit in the treatment of alopecia areata. Over the last few years, topical JAK inhibitors have been explored as safer options to the oral JAK inhibitors. However, despite the great excitement there remains some debate as to how well the topical JAKs really work. What has desperately been needed is a placebo controlled study and a study that compares topical JAK inhibitors to topical steroids.

Dr Rod Sinclair’s group from Australia conducted a 28 week prospective, placebo-controlled, double-blind study in patients with alopecia universalis investigating hair regrowth with two topical JAK inhibitors, 2% tofacitinib ointment twice daily and 1% ruxolitinib ointment twice daily. Topical clobetasol ointment was the active comparator while vehicle was used as the placebo control. 
Sixteen patients were recruited for the study. Six patients demonstrated partial hair regrowth in scalp areas treated with 2% tofacitinib. Five patients demonstrated partial hair regrowth in the areas treated with 1% ruxolitinib. Ten patients demonstrated partial hair regrowth in the areas treated with clobetasol. No regrowth was observed in the placebo treated areas.

This preliminary study is interesting because it does lend support to potential benefits of JAK inhibitors and shows they are likely better than placebo. What is questionable in this study is whether use of an ointment truly is the best vehicle to study for alopecia trials. Dr Brett King’s study in 2018 showed that tofacitinib ointment really didn’t work very well (reference below). One wonders whether JAK topical liposomal creams in this study would have provided similar or possibly even better outcomes and whether they could have even performed better than clobetasol.

More studies of topical JAK inhibitors are needed and comparison with a placebo should ideally be standard protocol in order to acquire a better sense of how well topical JAKs really work.

Reference 

Bokhari L, et al. Int J Dermatol. 2018.
Liu et al. J Am Acad Dermatol. 2018.