Conventional arthritis drug offers new hope for treating severe alopecia

(ORDO NEWS) — It may seem that rheumatoid arthritis and a severe form of hair loss called alopecia areata do not have much in common. One of them causes pain and swelling of the joints, and the other leads to a sharp, pinpoint hair loss.

But in both cases, the immune system decides that the body’s own cells are a threat – in alopecia, the immune system attacks the hair follicles, and in arthritis, the tissues of the joints.

However, interestingly, a new phase III clinical trial study has shown that the treatments for the two diseases may also be similar: an arthritis drug called baricitinib effectively treats alopecia areata in a third of patients.

This is not a silver bullet for Alopecia areata sufferers, but it is an exciting medical development that will hopefully be available to patients soon as a treatment option.

“Alopecia areata is a crazy journey marked by chaos, confusion and deep sadness for many who suffer from it,” says Yale University dermatology researcher Brett King.

“These large, controlled trials tell us that we can alleviate some of the suffering from this terrible disease.”

The reason this works is because of a protein called Janus kinase or JAKs. These enzymes are part of a signaling pathway called JAK-STAT that is involved in many areas, including the immune system.

JAK inhibitors, such as baricitinib, can dampen the immune response in some patients, allowing hair follicles to start growing again.

The trials were double-blind, randomized, placebo-controlled, making them the gold standard for analyzing the efficacy of baricitinib in patients with severe alopecia.

The researchers divided 1,200 patients into three groups. Participants received either a placebo, 2 milligrams of baricitinib, or 4 milligrams of baricitinib for 36 weeks. For those who received 4 milligrams of baricitinib, the results were most impressive, with more than a third of patients experiencing significant hair growth.

To assess the effectiveness of the drug in the study, the so-called Severity of Alopecia Tool (SALT) was used. The score is from 0 (no hair loss) to 100 (complete head hair loss).

At the start of the study, all participants had a SALT score of over 50, and by the end of the study, about 35 percent of patients taking 4 milligrams of baricitinib had a SALT score of 20 or less—an impressive result.

About 20 percent of patients who took 2 milligrams of baricitinib also scored 20 or less.

“The primary outcome was a SALT score of 20 or less at week 36. A SALT score of 20 or less was identified as a significant treatment outcome for patients with severe alopecia,” the group wrote in their study.

“Most of the patients in whom the primary outcome was achieved had a SALT score of 10 or less at week 36.”

Unfortunately, this was not without side effects for all patients: researchers reported a range of symptoms in test groups compared to controls, including worsening acne, upper respiratory tract infections, headaches, UTIs, and elevated cholesterol levels.

In addition, because of the drug’s ability to disrupt the immune system, it can also reduce the immune system’s ability to defend the body against real threats, and increased infections have previously been seen in those who used the drug to treat arthritis.

Despite this, however, very few participants in the new study dropped out due to side effects, suggesting they were generally tolerable.

Additional studies are currently underway to confirm the safety and effectiveness in the long term, but these results are encouraging.

This study was funded by pharmaceutical company Eli Lilly and Company, which markets baricitinib under the trade name Olumiant, which is currently indicated for the treatment of rheumatoid arthritis.

Now that the phase 3 results of this study have been completed and look promising, we may soon see this drug being used to treat severe hair loss as well, possibly bringing relief to many patients.


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