Treatment outcome of oral tofacitinib and ruxolitinib in patients with alopecia areata: A systematic review and meta-analysis.

BACKGROUND: Tofacitinib and ruxolitinib have been used off-label to treat alopecia areata. Although a number of case reports and small studies have been published, there are no comprehensive reviews examining the outcomes of using tofacitinib and ruxolitinib for the treatment of alopecia areata. AIMS: The aim of the study was to examine the outcome of patients with alopecia areata treated with oral tofacitinib or ruxolitinib in previously published studies. METHODS: A search of MEDLINE, Embase and Cochrane library was conducted. A systematic review and meta-analysis were performed focusing on the Severity of Alopecia Tool 50 achievement rate, the frequency of adverse events and recurrence after discontinuation of treatment. RESULTS: A total of 1244 studies were identified of which only 12 studies met the inclusion criteria. Of the 346 patients in these 12 studies, 288 had received oral tofacitinib and 58 had received oral ruxolitinib. The overall Severity of Alopecia Tool50 achievement rate was 66% (95% confidence interval, 54%-76%). Subgroup analysis revealed that drug choice, mean age, sex ratio and alopecia areata subtype ratio did not significantly affect the treatment response. Infections and laboratory abnormalities were the most common adverse events (98 and 65 cases of 319 patients, respectively). Patients treated for more than six months had a greater frequency of laboratory abnormalities as compared to those treated for shorter durations (24% vs. 7%; P = 0.04). Recurrence of alopecia areata was observed within three months after discontinuation of treatment in the majority (74%) of patients. LIMITATIONS: This analysis was limited by the small number of observational studies available for review, the heterogeneity of patient characteristics and the lack of long-term data. CONCLUSION: Both oral tofacitinib and ruxolitinib are effective and well tolerated in the treatment of alopecia areata. Clinicians should be aware of the expected efficacy, adverse events and high recurrence rate of oral JAK inhibitors for alopecia areata to effectively counsel these patients before starting therapy.

Breakthrough invasive infection due to Debaryomyces hansenii (teleomorph Candida famata) and Scopulariopsis brevicaulis in a stem cell transplant patient receiving liposomal amphotericin B and caspofungin for suspected aspergillosis.

An allogeneic stem cell transplant recipient developed pulmonary infiltrates and Aspergillus antigenemia during prophylactic low-dose liposomal amphotericin B. No response to therapy was observed after increasing the dose of liposomal amphotericin B and addition of caspofungin, and breakthrough candidemia developed. Therapy switch to voriconazole did not prevent the development of lethal septic shock. Shortly before death, Scopulariopsis brevicaulis was cultured from bronchial secretions, and positive blood cultures demonstrated persistent candidemia due to Debaryomyces hansenii, teleomorph of Candida famata.

[Acceleration by isaxonine of muscle reinnervation. Electrophysiological demonstration in leprotic neuropathy (author's transl)]. / Accélération de la réinnervation musculaire par l'isaxonine. Mise en évidence électrophysiologique au cours des neuropathies hanséniennes.

On a model of compressive human neuropathy--leprous neuropathy occuring below an osteoligamentary canal following a process of sclerosis--a double-blind survey of isaxonine versus a placebo was undertaken after matching of patients to obtain similar pairs. After four months of treatment with isaxonine, the electrophysiological tests (EMG of the anterior tibialis and of the abductor digiti minimi muscle) showed a very significant improvement in the graphs of patients receiving the active agent, as compared to a lack of improvement, even an aggravation for those patients receiving the placebo. It may thus be concluded that muscular reinnervation has occurred, either by sprouting of the remaining healthy fibers or by regeneration of the damaged axons, or by both phenomena simultaneously.

El Bactrim en el mal perforante plantar hanseniano

As a first step, two groups of 34 leprosy patients with perforating ulcers were included in this...

The treatment of leprosy with a new long-acting sulfonamide

The results obtained in 17 cases of lepromatous leprosy treated with a long-acting sulfonamide, Ro 4-4393, are reported. Clinically, two cases had marked improvement, four slight improvement, and one was unchanged. One patient became improved, and three did not change. Tolerance to the drug was excellent.