Two cases in which tofacitinib effectively treated both ulcerative colitis and alopecia areata
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CASE REPORT
Two cases in which tofacitinib effectively treated both ulcerative colitis and alopecia areata Oki Kikuchi1 · Daisuke Saito1 · Miki Miura1 · Haruka Wada1 · Ryo Ozaki1 · Sotaro Tokunaga1 · Shintaro Minowa1 · Masahiro Fukuyama2 · Tatsuya Mitsui1 · Akihito Sakuraba1 · Mari Hayashida1 · Jun Miyoshi1 · Minoru Matsuura1 · Manabu Ohyama2 · Tadakazu Hisamatsu1 Received: 23 March 2020 / Accepted: 29 May 2020 © Japanese Society of Gastroenterology 2020
Abstract A 40-year-old woman (case 1) visited the hospital complaining of diarrhea and was diagnosed with ulcerative colitis (UC). She was administered 5-aminosalicylic acid (5-ASA), but developed intolerance. Prednisolone (PSL) was administered, and her symptoms improved. However, alopecia areata developed as the PSL was tapered, and her UC relapsed. Adalimumab, Infliximab (IFX), and golimumab were used, but all showed insufficient efficacy. Therefore, we started tofacitinib (TOF). Her bloody stools and diarrhea improved 3 days after TOF administration, and clinical remission occurred on day 14. Her alopecia areata improved 14 days after starting TOF and improved completely during TOF maintenance therapy. A 19-year-old man (case 2) had developed alopecia areata at 10 years old and was diagnosed with UC at 17 years old. He achieved sustained remission with IFX, but then stopped IFX to receive a live vaccination. His UC relapsed 4 months later, immediately after the live vaccine was administered. Vedolizumab was administered, but was ineffective, as was re-administration of IFX. TOF was administered, and his clinical symptoms improved 7 days later. He achieved clinical remission on day 20. In addition, his hair began to regrow 14 days after starting TOF. Keywords Alopecia areata · Tofacitinib · Ulcerative colitis Abbreviations 5-ASA 5-Aminosalicylic acid JAK Janus kinase IFX Infliximab PSL Prednisolone STAT Signal transducers and activation of transcription TOF Tofacitinib UC Ulcerative colitis
* Daisuke Saito [email protected]‑net.ne.jp 1
Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, 6‑20‑2 Shinkawa, Mitaka‑shi, Tokyo 181‑8611, Japan
Department of Dermatology, Kyorin University School of Medicine, 6‑20‑2 Shinkawa, Mitaka‑shi, Tokyo 181‑8611, Japan
2
Introduction Ulcerative colitis (UC) is a chronic inflammatory disease of the colon that causes symptoms, such as bloody stool, diarrhea, and abdominal pain. The mechanisms involved in UC development remain unclear, and the etiology remains unknown. Factors, such as heredity, intestinal bacteria, and the environment have been suggested [1, 2]. UC treatment has dramatically progressed in the recent years, and various new molecular-targeting therapeutic agents, such as TNFα inhibitors, anti-α4β7 antibodies, and Janus kinase (JAK) inhibitors, have been developed; however, their proper use remains unestablished. JAK-signal transducers and activation of transcription (STAT) pathways play various roles in inflammation, antiviral activation, and cell growth. The JAK famil
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