JAK抑制剂治疗斑秃的现状、前景及其启示

Insights,current status and future perspective of JAK inhibitors in the treatment of alopecia areata

斑秃是一种慢性、异质性炎症性疾病,确切病因未明,虽治疗方法众多,但无特效药,也无对所有患者有效的疗法,加之部分慢性、重度患者对常规治疗反应差,因此急需新型有效的治疗方法。2014年起国外应用JAK抑制剂治疗斑秃,取得确切疗效。JAK抑制剂治疗斑秃的机制主要是抑制免疫细胞产生炎症因子,还可能直接作用于毛囊上皮细胞,推动毛囊周期进入生长期,有效率可达70%~80%,尤其是对重症和激素治疗无效的患者有很好的应用前景。虽其存在价格高、有潜在感染倾向等副作用,但仍不失为重症斑秃治疗的有效和二线措施。本文主要阐述JAK抑制剂的作用机制和治疗斑秃的现状、前景以及由此引发的对斑秃发病机制的启示。

Alopecia areata(AA)is a chronic heterogeneous inflammatory disease,with unknown pathogenesis.Although there are quite a few options to choose for treatment of AA,there is no specific therapic method,and neither is one therapic method for all patients.In addition,few patients with chronic course and severe type respond poorly to routine treatment.Therefore,we have urgent need for new and effective treatment.From 2014 to now,JAK inhibitors has been shown satisfactory effect on patients with AA internationally.The mechanism of JAK inhibitors in AA management is mainly through inhibiting production of cytokines by immune cells and acting to follicular epithelial cells towards anagen.According to those data from published papers and those from our study,the efficacy rate of JAK inhibitors is up to 70%~80%,especially for severe AA patients or patients with poor responder to steroid treatment.Due to high cost and potential possibility of infection,it is only used as a second line treatment.Both mechanism of action and treatment from published papers have been reviewed in this paper,as well as the insights of this new medication.