For several years now Janus Kinase (JAK) inhibitors have been the latest breakthrough in Alopecia Areata treatment. Rather than suppressing the entire immune system like conventional immunosuppressants, JAK inhibitors like Tofacitinib (Xeljanz/Xeljanz XR) and Ruxolitinib (Jakavi) suppress a specific biochemical pathway called the Janus Kinase pathway, which is involved in the autoimmune response seen in Alopecia Areata. This targeted immunomodulating therapy can selectively suppress the dysfunctional JAK pathway in Alopecia Areata patients while leaving the rest of their immune system alone. Prior to this finding, JAK inhibitors Tofacitinib and Ruxolitinib were used to treat other autoimmune diseases like Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA), Ulcerative Colitis (UC), and rare blood cancers.

As with any medication, particularly oral immunosuppressants, there are potential risks that need to be considered before taking the drug. JAK inhibitors are generally well tolerated by patients, but this does not eliminate the potential risks associated with them. Understandably, people with Alopecia Areata are eager to grow their hair back, and in many cases are willing to try just about anything. However, it is important to acknowledge and evaluate the risks associated with any medication, particularly JAK inhibitors, before you take them. These risks must be evaluated by the prescribing physician (usually a dermatologist) before Alopecia Areata patients can safely take the drug. If your physician determines you’re a suitable patient for JAK inhibition, they will continually assess you for the risks during the course of treatment.

Though they are not common, patients taking JAK inhibitors such as Tofacitinib and Ruxolitinib have an increased risk of sometimes serious infections, malignancies such as lymphoma and other lymphoproliferative disorders, and increased liver enzymes found in the blood. Patients with acute or chronic liver damage are advised against the use of JAK inhibitors as they are at risk of drug-induced liver damage. Health Canada, the national government agency responsible for drug safety in Canada, also found a link between JAK inhibition using Tofacitinib and venous thromboembolic events (VTE). These VTE’s can manifest as blood clots in the veins of the legs and arms, or blood clots in the lungs, known as a pulmonary embolism. There is a possible link between VTE and Ruxolitinib. Though most patients taking JAK inhibitors who experienced a VTE had at least one cardiovascular risk factor, all patients considering taking a JAK inhibitor must be evaluated for this risk.

In short, JAK inhibitors have shown to be a promising new treatment for Alopecia Areata, especially in those with long-standing, severe types of AA like Alopecia Totalis and Universalis. Though the goal of treatment is to regrow hair, patient safety takes priority. Part of ensuring patient safety is to fully assess the risks associated with treatment and determining whether it is safe to pursue. Have an open and thorough discussion with your dermatologist about the risks associated with JAK inhibitors to see if they are right for you.

Best of luck in your Alopecia Areata treatment!

 

Related Resources:

VTE and JAK Inhibitors: https://hpr-rps.hres.ca/reg-content/summary-safety-review-detail.php?lang=en&linkID=SSR00240

Tofacitinib: https://health-products.canada.ca/dpd-bdpp/info.do?lang=en&code=90863

Ruxolitinib: https://health-products.canada.ca/dpd-bdpp/info.do?lang=en&code=87357