Alopecia areata

Alopecia Areata and its Treatment Insights.

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Alopecia areata (AA) stands out as the main cause oflocalized hair loss, manifesting in patchy patterns on the scalp and other hair-bearing regions of the body (1). It affects up to 2% of the global population, with its impact spanning all ages, the prevalence appears higher in children than in adults (2). AA significantly impairs the quality of life (QoL), often correlating with depression or anxiety (1).  

Alopecia Areata 

Individuals with specific autoimmune disorders, including psoriasis, thyroid disease, or vitiligo, as well as those with allergic conditions like hay fever, have an increased likelihood of developing AA (3). Hair loss is a common manifestation of AA, and individuals with more extensive hair loss may also experience nail changes, such as ridges and pits (3). These alterations in the nails can be particularly prominent in certain cases (3). The severity of AA is represented in Figure 1 (3,4). 

Figure 1. Classification of AA based on its degree or severity (3,4). 
 

Treatment of Alopecia Areata 

The severity of hair loss and the patient’s age emerge as pivotal considerations in clinical management (5). The objective of treatment is to impede the progression of the disease while promoting hair regrowth (5). Table 1 provides a variety of treatment options for AA (5). 
Table 1: Treatment options for AA (5). 

Conclusion 

AA significantly impacts patients’ QoL due to its diverse clinical manifestations (1). Managing AA, particularly in severe cases, remains a significant challenge. HCPs must diligently identify and manage concurrent skin infections in AA patients to improve treatment outcomes and enhance overall QoL. Consequently, the need for additional clinical trials of drugs for AA is imperative to ensure patient safety and optimize therapeutic approaches. 

Litfulo becomes first FDA-approved treatment for adolescents with severe alopecia

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Key takeaways:

  • Litfulo is the first FDA-approved treatment for severe alopecia in patients aged as young as 12 years.
  • The approval was based on results from a phase 2b/3 trial recently published in The Lancet.

The FDA has approved Litfulo, a once-daily oral treatment, for the treatment of severe alopecia in individuals aged 12 years and older, Pfizer announced in a press release.

Litfulo (ritlecitinib), a selective dual Janus kinase 3 and tyrosine family kinase inhibitor, is now the first-ever FDA-approved treatment for severe alopecia in adolescents, according to the press release.

“Litfulo is an important treatment advancement for alopecia areata, an autoimmune disease that previously had no FDA-approved options for adolescents and limited options available for adults,” Angela Hwang, chief commercial officer and president of global biopharmaceuticals business at Pfizer, said in the release. “With today’s approval, adolescents and adults who struggle with substantial hair loss have an opportunity to achieve significant scalp hair regrowth.”

Data from ALLEGRO, a phase 2b/3 trial recently published in The Lancet, were used to support the approval.

Results from the study showed that 23% of patients treated with 50 mg of Litfulo achieved 80% or greater scalp hair coverage after 6 months of treatment, whereas 1.6% of placebo-treated patients achieved the same.

Litfulo exhibited similar efficacy and safety outcomes across all age groups. Most adverse events were well-tolerated by patients with the most common being headaches (10.8%), diarrhea (10%), acne (6.2%), rashes (5.4%) and urticaria (4.6%). Sixteen serious adverse events were reported in 14 patients; however, there were no major events or deaths.

According to the release, Litfulo will be available in the coming weeks.

Reference:

Perspective

Back to Top Maryanne Senna, MD)

Maryanne M. Senna, MD

For decades, when patients with severe alopecia areata sought treatment for their condition, the therapies available were either incredibly painful, led to significant long term side effects or were ineffective. Last year, our ability to care for this patient population was transformed with the first FDA approval of a JAK inhibitor for severe alopecia areata in adults. However, the adolescent and young adult alopecia areata population — one that is particularly affected by this chronic autoimmune hair loss condition — was still left without a favorable option.

Adolescence is a complex period of development and an important time of growth and discovery. As a dermatologist and hair loss specialist, I routinely witness the profound negative impact that severe alopecia can have on this patient population. Teens who were once successful students and athletes start avoiding school, sports practice and social activities. These adolescents commonly develop depression and anxiety, and many will experience bullying by their peers.

The FDA approval of ritlecitinib has paved the way for a brighter future for these patients. By successfully treating their alopecia, these adolescents and young adults are able to once again confidently navigate their lives, free from the burdens of stigma and chronic disease. By targeting underlying mechanisms of alopecia, this innovative therapy not only promotes hair regrowth but also effectively mitigates the emotional and social burdens associated with alopecia areata, empowering patients to realize their true potential.

Maryanne M. Senna, MD

Assistant Professor of Dermatology at Harvard Medical School Director of Lahey Hair Loss Center of Excellence at Lahey Hospital and Medical Center

Alopecia With Endocrine Therapies in Patients With Cancer.

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Abstract

Background. Whereas the frequency of alopecia to cytotoxic chemotherapies has been well described, the incidence of alopecia during endocrine therapies (i.e., anti-estrogens, aromatase inhibitors) has not been investigated. Endocrine agents are widely used in the treatment and prevention of many solid tumors, principally those of the breast and prostate. Adherence to these therapies is suboptimal, in part because of toxicities. We performed a systematic analysis of the literature to ascertain the incidence and risk for alopecia in patients receiving endocrine therapies.

Methods. An independent search of citations was conducted using the PubMed database for all literature as of February 2013. Phase II–III studies using the terms “tamoxifen,” “toremifene,” “raloxifene,” “anastrozole,” “letrozole,” “exemestane,” “fulvestrant,” “leuprolide,” “flutamide,” “bicalutamide,” “nilutamide,” “fluoxymesterone,” “estradiol,” “octreotide,” “megestrol,” “medroxyprogesterone acetate,” “enzalutamide,” and “abiraterone” were searched.

Results. Data from 19,430 patients in 35 clinical trials were available for analysis. Of these, 13,415 patients had received endocrine treatments and 6,015 patients served as controls. The incidence of all-grade alopecia ranged from 0% to 25%, with an overall incidence of 4.4% (95% confidence interval: 3.3%–5.9%). The highest incidence of all-grade alopecia was observed in patients treated with tamoxifen in a phase II trial (25.4%); similarly, the overall incidence of grade 2 alopecia by meta-analysis was highest with tamoxifen (6.4%). The overall relative risk of alopecia in comparison with placebo was 12.88 (p < .001), with selective estrogen receptor modulators having the highest risk.

Conclusion. Alopecia is a common yet underreported adverse event of endocrine-based cancer therapies. Their long-term use heightens the importance of this condition on patients’ quality of life. These findings are critical for pretherapy counseling, the identification of risk factors, and the development of interventions that could enhance adherence and mitigate this psychosocially difficult event.

 

Source: The Oncologist.

 

 

Factors Influencing the Effectiveness of Scalp Cooling in the Prevention of Chemotherapy-Induced Alopecia.

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Abstract

Introduction. The success of scalp cooling in preventing or reducing chemotherapy-induced alopecia (CIA) is highly variable between patients and chemotherapy regimens. The outcome of hair preservation is often unpredictable and depends on various factors.

Methods. We performed a structured search of literature published from 1970 to February 2012 for articles that reported on factors influencing the effectiveness of scalp cooling to prevent CIA in patients with cancer.

Results. The literature search identified 192 reports, of which 32 studies were considered relevant. Randomized studies on scalp cooling are scarce and there is little information on the determinants of the result. The effectiveness of scalp cooling for hair preservation depends on dose and type of chemotherapy, with less favorable results at higher doses. Temperature seems to be an important determinant. Various studies suggest that a subcutaneous scalp temperature less than 22°C is required for hair preservation.

Conclusions. The effectiveness of scalp cooling for hair preservation varies by chemotherapy type and dose, and probably by the degree and duration of cooling.