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Expert Opinion on Emerging Drugs Mar 2018Alopecia Areata is a common form of non-scarring hair loss that usually starts abruptly with a very high psychological impact. Due to the still not completely understood... (Review)
Review
Alopecia Areata is a common form of non-scarring hair loss that usually starts abruptly with a very high psychological impact. Due to the still not completely understood etiopathogenesis, at present there is no treatment that can induce a permanent remission and there is no drug approved for the treatment of this disorder. Areas covered: Leading existing treatment are briefly overviewed and then ongoing research on Janus Kinases Inhibitors is discussed, reviewing trials with oral and topical formulations so as new opportunities for other forms of alopecia, such as cicatricial alopecia. Expert opinion: JAK inhibitors represent a promise among alopecia treatments, but further studies are needed on long term safety. There is still no validated dosage for alopecia areata and the vehicles used for topical formulations seem not yet ideal in terms of skin penetration and reduced systemic absorption. Hopefully several studies are ongoing and we hope, in the near future, that JAK inhibitors will become part of the armamentarium to treat alopecia areata patients in terms of safety and costs.
Topics: Administration, Oral; Administration, Topical; Alopecia Areata; Animals; Drug Design; Humans; Janus Kinase Inhibitors
PubMed: 29466675
DOI: 10.1080/14728214.2018.1444750 -
Journal of Drugs in Dermatology : JDD Sep 2023Alopecia areata (AA) is a debilitating autoimmune disease that results in non-scarring hair loss. Baricitinib is the Food and Drug Administration (FDA) approved... (Review)
Review
BACKGROUND
Alopecia areata (AA) is a debilitating autoimmune disease that results in non-scarring hair loss. Baricitinib is the Food and Drug Administration (FDA) approved treatment for AA. Objective: Review the mechanism of action, pharmacokinetics, pharmacodynamics, efficacy, and safety of baricitinib in the treatment of AA. Methods: A literature review was conducted using the MEDLINE (PubMed) and EMBASE databases for articles published between January 2010 to November 2022. Articles in English discussing baricitinib's efficacy and safety in AA, pharmacodynamic, and pharmacokinetic profiles were included.
RESULTS
Two identical phase III trials (BRAVE-AA1 and BRAVE-AA2) were evaluated. A greater percentage of subjects receiving baricitinib 4 mg or 2 mg dose achieved a Severity of Alopecia Tool score equal to or less than 20 vs placebo. In BRAVE-AA1, for 4 mg, 2 mg, and placebo, respectively, these values were 38.8%, 22.8%, and 6.2%; in BRAVE-AA2, these values were 35.9%, 19.4%, and 3.3% (P<0.001).
DISCUSSION
Baricitinib is the first FDA-approved treatment for AA. Other treatments for AA are used off-label with variable efficacy. Baricitinib is associated with black-box warnings due to adverse effects (AEs) associated with other Janus Kinase (JAK) inhibitors or use in other diseases. In the two large AA trials, AEs were considered mild or moderate; those reported more often with baricitinib than placebo included acne, elevations of low- and high-density lipoprotein cholesterol, and elevation of creatinine kinase. Baricitinib is a relatively tolerable and safe therapeutic alternative for severe AA, although additional study is needed to assess its long-term efficacy and safety. Citation: Singh R, Driscoll MS. Review of baricitinib in the treatment of alopecia areata. J Drugs Dermatol. 2023;22(9):935-939. doi:10.36849/JDD.7357.
Topics: United States; Humans; Alopecia Areata; Azetidines; Purines; Janus Kinase Inhibitors
PubMed: 37683061
DOI: 10.36849/JDD.7357 -
Archives of Dermatological Research Jan 2022
Topics: Alopecia Areata; Humans; Terminology as Topic
PubMed: 33646364
DOI: 10.1007/s00403-021-02199-x -
Expert Review of Clinical Immunology 2015Alopecia areata (AA) development is associated with both innate and adaptive immune cell activation, migration to peri- and intra-follicular regions, and hair follicle... (Review)
Review
Alopecia areata (AA) development is associated with both innate and adaptive immune cell activation, migration to peri- and intra-follicular regions, and hair follicle disruption. Both CD4(+) and CD8(+) lymphocytes are abundant in AA lesions; however, CD8(+) cytotoxic T lymphocytes are more likely to enter inside hair follicles, circumstantially suggesting that they have a significant role to play in AA development. Several rodent models recapitulate important features of the human autoimmune disease and demonstrate that CD8(+) cytotoxic T lymphocytes are fundamentally required for AA induction and perpetuation. However, the initiating events, the self-antigens involved, and the molecular signaling pathways, all need further exploration. Studying CD8(+) cytotoxic T lymphocytes and their fate decisions in AA development may reveal new and improved treatment approaches.
Topics: Alopecia Areata; Autoantigens; Autoimmune Diseases; CD4-Positive T-Lymphocytes; CD8-Positive T-Lymphocytes; Humans; Signal Transduction
PubMed: 26548356
DOI: 10.1586/1744666X.2015.1085306 -
The Journal of Investigative... Jan 2018During its 25th anniversary year, the National Alopecia Areata Foundation (NAAF) undertook a project to completely re-evaluate their research program and to help focus...
During its 25th anniversary year, the National Alopecia Areata Foundation (NAAF) undertook a project to completely re-evaluate their research program and to help focus and direct future directions of alopecia areata (AA) research to better meet the goals of individuals with and the scientists working to discover mechanisms of disease and better treatments for AA. This project was embodied in five research summits in 2008, 2009, 2010, 2012, and 2014 as part of the NAAF's main strategic initiative, the Alopecia Areata Treatment Development Program, to accelerate progress toward a viable treatment. The sixth summit, "Building and Crossing the Translational Bridge," was held in 2016 and highlighted strong clinical data on the efficacy of topical and oral JAK inhibitors in mouse models and human AA. The advances discussed in this most recent summit provide real hope for a reliable and relatively safe treatment for AA. This work validates the last 10 years of research translating basic research of AA into new treatments based on the firm foundation of modern immunologic and genetic research.
Topics: Alopecia Areata; Biomedical Research; Humans
PubMed: 29273097
DOI: 10.1016/j.jisp.2017.10.011 -
CMAJ : Canadian Medical Association... Apr 2021
Topics: Adult; Alopecia Areata; Anti-Bacterial Agents; Humans; Male; Penicillins; Syphilis, Cutaneous
PubMed: 33846209
DOI: 10.1503/cmaj.200894-f -
Acta Dermato-venereologica Nov 2023Several non-randomized clinical trials and retrospective studies have demonstrated encouraging efficacy and well-tolerated safety of tofacitinib in the treatment of... (Observational Study)
Observational Study
Several non-randomized clinical trials and retrospective studies have demonstrated encouraging efficacy and well-tolerated safety of tofacitinib in the treatment of alopecia areata. However, there are scarce data on a large cohort of patients with alopecia areata in long-term real-world practice. This single-centre, retrospective, observational cohort study included 126 patients with alopecia areata treated with tofacitinib between February 2021 and December 2022. The aims of this study are to evaluate drug survival, effectiveness and safety of tofacitinib for treatment of alopecia areata, and to identify potential factors influencing long-term outcomes. Median duration of treatment was 23.00 (interquartile range (IQR) 15.00, 47.25) weeks. Median all-cause survival time of 126 patients treated with tofacitinib was 44 weeks (95% confidence interval (95% CI) 36.3, 51.7), and the all-cause drug retention rate at 12 weeks, 24 weeks and 48 weeks were 90.0%, 66.4% and 42.3%, respectively. The most common reason for discontinuation was complete remission/satisfaction. A total of 80 patients treated with tofacitinib for over 6 months were included in the efficacy analysis, the overall complete response rate at 24 weeks was 33.8% (27/80). No life-threatening serious adverse events occurred. Sex is an independent risk factor in predicting patient outcomes. This real-world study confirmed the high effectiveness and acceptable safety profile of tofacitinib in alopecia areata, with a satisfactory drug survival rate, and provides supporting data for the clinical application of tofacitinib in Chinese patients with alopecia areata.
Topics: Humans; Alopecia Areata; Retrospective Studies; Protein Kinase Inhibitors; Pyrroles
PubMed: 37955531
DOI: 10.2340/actadv.v103.13475 -
Skin Therapy Letter May 2023Oral Janus kinase (JAK) inhibitors now have a position as first-line agents for treating advanced alopecia areata. Oral JAK inhibitors are considerably more effective... (Review)
Review
Oral Janus kinase (JAK) inhibitors now have a position as first-line agents for treating advanced alopecia areata. Oral JAK inhibitors are considerably more effective than topical JAK inhibitors, although topical agents may still have a valuable role for specific subgroups of patients. The US FDA approval of baricitinib in 2022 was an important milestone. Numerous JAK inhibitors are now being intensely studied for use in alopecia areata and several additional medications may also become approved in the near future. Accumulating clinical trial data points to a generally good safety profile for JAK inhibitors when used for patients with alopecia areata. However, long-term data pertaining to the safety and efficacy in this patient population are lacking.
Topics: Humans; Janus Kinase Inhibitors; Alopecia Areata
PubMed: 37339501
DOI: No ID Found -
Journal of Cosmetic Dermatology Oct 2022
Topics: Humans; Alopecia Areata; Platelet-Rich Plasma; Stromal Vascular Fraction
PubMed: 35181998
DOI: 10.1111/jocd.14860 -
Skinmed 2016The prognosis of alopecia areata is better in cases with single and small lesions, and the variability of the extension of the disease is one of the criteria for the... (Review)
Review
The prognosis of alopecia areata is better in cases with single and small lesions, and the variability of the extension of the disease is one of the criteria for the choice of treatment modality. Several medications have been described in the literature for the treatment of alopecia areata, including corticosteroids, minoxidil, and diphencyprone. The authors review treatments for alopecia areata.
Topics: Adrenal Cortex Hormones; Alopecia Areata; Cyclopropanes; Humans; Minoxidil; Prognosis; Vasodilator Agents
PubMed: 27871349
DOI: No ID Found