Characteristics and predictive values of super-responders in alopecia areata under tofacitinib treatment: a single-centre retrospective study

BACKGROUND: Alopecia areata (AA) is an autoimmune disorder characterized by nonscarring hair loss, significantly impacting patients' quality of life. Rapid hair regrowth is the primary goal of treatment, particularly for super-responders (SRs), who demonstrate remarkable and swift improvement. The advent of Janus kinase (JAK) inhibitor treatment has transformed AA management, yet predictors of SRs in AA remain underexplored. OBJECTIVES: This study aimed to characterize SRs among patients with AA treated with tofacitinib, identify clinical and demographic predictors of SRs, and analyse treatment outcomes over 12 months. METHODS: We conducted a single-centre, longitudinal retrospective analysis of 80 patients with AA treated with tofacitinib at Xiangya Hospital, Central South University, Changsha, China, from February 2021 to August 2024. Patients were classified as SRs if they achieved a ≥ 80% reduction in the Severity of Alopecia Tool (SALT) score by the 3rd month or a 100% reduction (SALT100) by the 6th month. Clinical data, treatment outcomes and potential predictors of SR status were analysed using binary logistic regression. RESULTS: SRs comprised 37.5% of the cohort. Significant predictors of SR status included older age and the absence of prior JAK inhibitor treatment. Female patients and those without previous corticosteroid use also trended towards higher SR rates, although these factors were not statistically significant. SRs demonstrated faster and more sustained hair regrowth, with 93% achieving SALT100 by 6 months, compared with 42% of non-SRs at 12 months. CONCLUSIONS: To our knowledge, this study is the first to define and characterize SRs in patients with AA treated with a JAK inhibitor, providing a reference for dermatologists to optimize AA management. Identifying SRs early may improve patient outcomes and inform treatment strategies, particularly in those with a history of JAK inhibitor use. Further research is warranted to validate these findings in larger, multicentre cohorts.