Abstract: 【Abstract】 Objective To analyze the real-world effectiveness and safety of tofacitinib in the treatment of alopecia ophiasis, and to compare characteristics of patients with different clinical responses. Methods A retrospective study was conducted on patients with alopecia ophiasis who visited the Department of Dermatology, China-Japan Friendship Hospital from March 1, 2022, to July 31, 2023. All patients received tofacitinib in combination with topical minoxidil or glucocorticoids, intralesional glucocorticoid injections, oral isotretinoin, antidepressants, antihistamines, traditional Chinese medicine, etc., and were followed up for 36 weeks. The primary outcome was the number of patients achieving complete remission and partial remission at week 36; secondary outcomes included the number of patients achieving a severity of alopecia tool （SALT） score of ≤ 20 points and those with a response rate of ≥ 50% in scalp hair regrowth （SALT50）. Clinical characteristics were compared between patients who achieved and did not achieve a SALT score of ≤ 20 points. Comparisons among groups were performed using the two-independent-sample t test, Mann-Whitney U test, and Fisher's exact test. Results A total of 21 patients with alopecia ophiasis were collected, and all received oral tofacitinib citrate at a dose of 5 mg twice daily for at least 36 weeks. After a 36-week follow-up, 2 patients （9.5%） achieved complete remission, 16 （76.2%） achieved partial remission, and 3 （14.3%） showed no response. SALT50 was achieved in 12 patients （57.1%）, and 13 （61.9%） had a SALT score of ≤ 20 points. Adverse reactions included mild liver transaminase elevation （1 case）, headache （1 case）, and folliculitis （2 cases）. At week 36, the patients achieving a SALT score of ≤ 20 points exhibited significantly decreased proportions of patients with body hair loss （7/13） and of patients with childhood-onset alopecia ophiasis （7/13） compared with those having a SALT score of > 20 points （both 8/8, both P = 0.046）. However, there were no significant differences between the above two groups in gender, age, body mass index, total disease duration, baseline SALT scores, positivity rates of thyroid antibodies or prevalence of total allergen-specific IgE abnormalities （all P > 0.05）. Conclusion Combination therapy with tofacitinib showed generally good efficacy and safety in the treatment of alopecia ophiasis, and poorer outcomes were likely to be observed in patients with body hair involvement and childhood-onset alopecia ophiasis.

Key words: Alopecia areata, Janus kinase inhibitors, Alopecia ophiasis, Tofacitinib, Treatment outcome