Alopecia Areata Clinical Case Review

Maryanne Senna, MD, assistant professor of dermatology at Harvard Medical School, discusses the results of the case and the impact JAK inhibitors have had on the treatment of alopecia areata:

"The patient returned to clinic 3 months and 6 months after treatment initiation. And as you can see from the results here, she had significant regrowth of all of her scalp hair, and she even was able to stop wearing her wig, which she was thrilled about. We repeated labs including a CBC with diff, CMP and lipid panel, and these all remained normal. She did have one side effect, which was a mild upper respiratory infection that occurred around month 4, and it self-resolved.

Now what’s important to recognize is that, while some patients will respond quickly like this to JAK inhibitors, other patients may take longer to respond. Alopecia areata can be a life altering disease, and may be associated with depression, anxiety and other major psychosocial and functional comorbidities. The treatments used for milder cases of alopecia areata do not work well in patients with severe disease, and can be incredibly painful, requiring numerous monthly scalp injections. Spontaneous regrowth of hair in patients with severe alopecia areata is exceedingly rare. Because of this, JAK inhibitors have really revolutionized our ability to effectively treat patients with alopecia areata that is severe. In clinical trials, JAK inhibitors were shown to be safe and effective in treating patients with severe alopecia areata, with approximately 40% of patients with severe [alopecia areata] achieving 80% or more of their scalp hair coverage within 36 to 48 weeks of treatment.

As I mentioned previously, we now have two oral JAK inhibitors that were recently FDA-approved for the treatment of severe alopecia areata. These medications are dosed once daily. Baricitinib, or Olumiant, is available in 2 mg or 4 mg per day doses, again, for severe alopecia areata in adults 18 years of age and up. And ritlecitinib is a once-daily 50 mg dose of a medication for severe [alopecia areata] in patients 12 years of age or older. It’s important when prescribing these medications that the practitioner review information on dosing, potential side effects and laboratory monitoring for JAK inhibitors that are noted in the package insert.

This is an incredibly exciting time for us in our ability to treat this patient population, and the smiles alone that I see on patients’ faces where they not only have their hair back, but as they say to me often, they have their life back, is really one of the greatest privileges of my job in caring for patients with hair loss. So thank you for your attention, and I hope you found this informative and helpful."