Abstract

BACKGROUND: The advent of Janus kinase inhibitors has revolutionized the management of alopecia areata (AA). However, evidence remains scarce regarding the maintenance of disease control following an individual-based taper strategy. OBJECTIVE: To assess the outcome of a patient-centered tofacitinib dosing regimen in patients with AA who were in complete remission. METHODS: This retrospective observational cohort study included 46 patients with AA who achieved complete hair regrowth on tofacitinib and underwent structured dose tapering between February 2021 and July 2025. Clinical outcomes, cumulative drug exposure, and adverse events were assessed over a 48-week follow-up period. RESULTS: Disease control (Severity of Alopecia Tool ≤10) was consistently maintained, with rates of 95.7% (44/46) at week 24 and 93.5% (43/46) at week 48, while loss of treatment benefit (Severity of Alopecia Tool ≥20) remained rare, occurring in 0.0% (0/46) at week 24 and 2.2% (1/46) at week 48. A successful dose reduction was achieved in 80.4% (37/46) of patients. By week 48, the individualized tapering strategy resulted in a cumulative reduction of 1198 mg in drug exposure, decreasing from 3360 mg to 2162 mg. No significant predictors of tapering success were identified. LIMITATIONS: Small sample size, relatively short duration of follow-up. CONCLUSION: A patient-centered tofacitinib tapering strategy is feasible for responders and may reduce treatment burden without compromising efficacy.