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This article discusses drug-induced hair loss, which can occur with many drugs including cytotoxic agents, biologics, and immunomodulating agents, among others. It outlines the diagnosis and management of drug-induced alopecia, with a focus on recently implicated drugs.

BACKGROUND:Alopecia areata is characterised by non-scarring loss of scalp, face, or body hair. We investigated the efficacy and safety of ritlecitinib, an oral, selective dual JAK3/TEC family kinase inhibitor, in patients with alopecia areata. METHODS:In this randomised, double-blind, multicentre, phase 2b-3 trial done at 118 sites in 18 countries, patients aged 12 years and older with alopecia areata and at least 50% scalp hair loss were randomly assigned to oral ritlecitinib or placebo once-daily for 24 weeks, with or without a 4-week loading dose (50 mg, 30 mg, 10 mg, 200 mg loading dose followed by 50 mg, or 200 mg loading dose followed by 30 mg), followed by a 24-week extension period during which ritlecitinib groups continued their assigned doses and patients initially assigned to placebo switched to ritlecitinib 50 mg or 200 mg loading dose followed by 50 mg. Randomisation was done by use of an interactive response system and was stratified by baseline disease severity and age. The sponsor, patients, and investigators were masked to treatment, and all patients received the same number of tablets to maintain masking. The primary endpoint was Severity of Alopecia Tool (SALT) score 20 or less at week 24. The primary endpoint was assessed in all assigned patients, regardless of whether they received treatment. This study was registered with ClinicalTrials.gov, NCT03732807. FINDINGS/RESULTS:Between Dec 3, 2018, and June 24, 2021, 1097 patients were screened and 718 were randomly assigned to receive ritlecitinib 200 mg + 50 mg (n=132), 200 mg + 30 mg (n=130), 50 mg (n=130), 30 mg (n=132), 10 mg (n=63), placebo to 50 mg (n=66), or placebo to 200 mg + 50 mg (n=65). 446 (62%) of 718 patients were female and 272 (38%) were male. 488 (68%) were White, 186 (26%) were Asian, and 27 (4%) were Black or African American. Of 718 patients randomly assigned, 104 patients discontinued treatment (34 withdrew, 19 adverse events [AEs], 12 physician decision, 12 lack of efficacy, 13 lost to follow up, five rolled over to long-term study transfer, four pregnancies, two protocol deviations, one declined to attend follow-up due to COVID-19, one attended last visit very late due to COVID-19, and one non-compliance). At week 24, 38 (31%) of 124 patients in the ritlecitinib 200 mg + 50 mg group, 27 (22%) of 121 patients in the 200 mg + 30 mg group, 29 (23%) of 124 patients in the 50 mg group, 17 (14%) of 119 patients in the 30 mg group, and two (2%) of 130 patients in the placebo group had a response based on SALT score 20 or less. The difference in response rate based on SALT score 20 or less between the placebo and the ritlecitinib 200 mg + 50 mg group was 29·1% (95% CI 21·2-37·9; p<0·0001), 20·8% (13·7-29·2; p<0·0001) for the 200 mg + 30 mg group, 21·9% (14·7-30·2; p<0·0001) for the 50 mg group, and 12·8% (6·7-20·4; p=0·0002) for the 30 mg group. Up to week 48 and including the follow-up period, AEs had been reported in 108 (82%) of 131 patients in the ritlecitinib 200 mg + 50 mg group, 105 (81%) of 129 patients in the 200 mg + 30 mg group, 110 (85%) of 130 patients in the 50 mg group, 106 (80%) of 132 patients in the 30 mg group, 47 (76%) of 62 patients in the 10 mg group, 54 (83%) of 65 patients placebo to ritlecitinib 200 mg + 50 mg in the extension period, and 57 (86%) of 66 patients in the placebo to 50 mg group. The incidence of each AE was similar between groups, and there were no deaths. INTERPRETATION/CONCLUSIONS:Ritlecitinib was effective and well tolerated in patients aged 12 years and older with alopecia areata. Ritlecitinib might be a suitable treatment option for alopecia areata in patients who are candidates for systemic therapy. FUNDING/BACKGROUND:Pfizer.

Background: The ALLEGRO Phase 2b/3 trial (NCT03732807) investigated the efficacy and safety of ritlecitinib, an oral JAK3/TEC inhibitor, in patients with alopecia areata (AA). This analysis evaluated the efficacy of ritlecitinib over a 48-week treatment period.
Method(s): Patients 12 years or older with AA and 50 percent scalp hair loss or more received daily ritlecitinib +/- a 4-week loading dose (200/50 mg, 200/30mg, 50mg, 30mg, 10mg [assessed for doseranging only]) or placebo for 24 weeks. During the subsequent 24-week extension period, ritlecitinib groups continued maintenance doses through Week 48; patients initially on placebo switched to ritlecitinib 200/50mg or 50mg. Endpoints included: proportions of patients with Severity of Alopecia Tool [SALT] score >=20 (primary), >=2-grade improvement in eyebrows/eyelashes, and Patients' Global Impression of Change (PGI-C) score of "moderately improved" or "greatly improved".
Result(s): Overall, 718 subjects were randomized. Significantly higher proportions of patients receiving ritlecitinib vs. placebo had SALT >=20 response as early as Week 8 for the 200/50mg group (P=0.008), Week 12 for 200/30mg (P=0.010) and Week 18 for 50mg (P<0.001) and 30mg (P=0.008). Proportions of patients with SALT >=20 response increased through Week 48: 40 percent (200/50mg), 34 percent (200/30mg), 43 percent (50mg), 31 percent (30 mg) and 10 percent (10mg). Proportions of patients with >=2-grade improvement in eyebrows/eyelashes or PGI-C response also increased up to Week 48 across ritlecitinib groups. Events of herpes zoster (8), pulmonary embolism (1) and breast cancer (2) were reported. No major adverse cardiovascular events, deaths or opportunistic infections were reported.
Conclusion(s): Ritlecitinib demonstrated sustained efficacy over 48 weeks in patients with AA with >=50% scalp hair loss

INTRODUCTION/BACKGROUND:Digital health solutions, specifically direct-to-consumer platforms, have been touted to make care accessible and convenient for patients. The aim of this article is to evaluate patients' reported reasons for choosing a platform for the treatment of hair loss and their experience. This platform (Keeps) is focused exclusively on the treatment of male pattern hair loss (MPHL) with approved medications such as oral finasteride and topical minoxidil. METHODS:In order to evaluate patients' motivations to choose the platform and their experience, we administered two distinct questionnaires, with a total of 8983 respondents. RESULTS:The results showed that patients on the platform report positive health outcomes at approximately 6 months, as 81% of respondents report hair regrowth or cessation of hair loss, and 91% never or rarely miss their medication. Additionally, the platform is expanding the market through education and awareness, as nearly 1 in 3 new patients, mostly in their 20s and early 30s, had never considered treating their hair loss before learning about this virtual care model. CONCLUSION/CONCLUSIONS:Such a model provides further insights into how digitally enabled care focused on a chronic condition, backed by quality and evidence-based initiatives, can expand access and improve care for androgenetic alopecia (AGA).

Female patterned hair loss (FPHL) is a common form of androgenetic alopecia in women and is characterized by a hormonally directed diffuse hair loss on the scalp. Management of FPHL is well described in the literature; however, treatment of FPHL in patients with co-morbid polycystic ovarian syndrome (PCOS), an endocrinologic condition found in reproductive-aged women, has not yet been reviewed. Due to the different pathomechanism of the diseases and complexity of FPHL in PCOS patients, this study aimed to review current diagnosis and management approaches for hair loss in PCOS patients specifically and highlight the growing need for more research in this growing patient population.

Alopecia areata is an autoimmune hair loss disorder with variations in distribution, duration, and severity. The disease is chronic and often follows an unpredictable course, frequently leading to stress and anxiety for those who suffer from it. Throughout the years more knowledge has been gained regarding pathogenesis, diagnostic tools, impact on quality of life, as well as treatment strategies for alopecia areata. However, challenges in treating and alleviating the burden of disease remain. In this article, we discuss updates regarding the pathogenesis and treatment of alopecia areata and highlight unmet needs of the condition, including a review of limitations of current treatments, accessibility to management strategies, and the need for disease awareness and advocacy.