Efficacy and Safety of Tofacitinib in Lichen Planopilaris: A Retrospective Series of 74 Patients.

Abstract

Background: Lichen planopilaris (LPP) is a rare, inflammatory condition leading to scarring alopecia, predominantly affecting middle-aged women. Traditional treatments have shown limited efficacy, highlighting the need for novel therapeutic approaches. Tofacitinib, a Janus kinase (JAK) inhibitor, has shown promise in treating various autoimmune diseases, including autoimmune dermatological disorders. This study aims to evaluate the efficacy of tofacitinib in treating patients with LPP.

Methods: We conducted a retrospective, single-center observational study at Shohadaye Tajrish Hospital, reviewing records of 74 patients with biopsy-confirmed LPP who had extensive and treatment-resistant disease. Patients were treated with tofacitinib 5 mg twice daily for at least 16 weeks. Efficacy was assessed using the LPP Activity Index (LPPAI), and adverse events were monitored.

Results: This study evaluated 74 patients with LPP, predominantly female (83.3%), with a mean age of 46.64±8.05 years. The mean LPPAI score significantly decreased from 4.61±1.26 before treatment to 1.73±1.68 after six months (P<0.0001). Response rates varied: 21.62% within 1‒3 months, 24.32% within 3‒6 months, 33.78% within 6‒12 months, and 8.10% within 12‒24 months, with 6.75% showing no response. Adverse effects included headache (8.10%), hyperlipidemia (2.70%), elevated liver enzymes (5.40%), nausea (6.75%), and high blood pressure (4.15%).

Conclusion: Tofacitinib represents a promising treatment for LPP, providing significant improvement in disease activity for most patients. Further research is needed to refine treatment protocols, understand predictors of response, and address gender-specific adverse effects.