A medicine used to treat arthritis has shown promising results in people with severe alopecia areata, an autoimmune condition that causes significant hair loss. Alopecia areata happens when the immune system mistakenly attacks the hair follicles. The follicles are not usually permanently damaged, which means hair can grow back if the immune attack is brought under control. However, existing treatments do not work for everyone, and there are limited options for some patients, including teenagers.
Researchers have now tested upadacitinib, an anti-inflammatory medicine already used to treat certain types of arthritis. The researchers carried out two large Phase 3 clinical trials to see whether the drug could help people with severe alopecia areata.
A total of 1,399 people aged between 12 and 64 took part in the two trials. This included 118 teenagers. Everyone involved had lost at least half of the hair on their scalp.
The participants were given a daily tablet for 24 weeks. Some received 15 milligrams of upadacitinib, some received 30 milligrams, while others received a placebo.
The researchers used the Severity of Alopecia Tool, or SALT, to measure hair loss and regrowth. A SALT score of 20 or less means that a person has at least 80 per cent of their scalp hair.
The results were much better among people taking upadacitinib than those taking the placebo.
In the two trials, 44.6 and 45.2 per cent of people taking the 15 milligram dose reached the target. Among those taking 30 milligrams, the figures were higher, at 54.3 and 55 per cent.
By comparison, only 1.5 and 3.4 per cent of people taking the placebo reached the same target.
The benefits also appeared fairly quickly. The researchers found a clear difference between the drug and the placebo from around eight weeks after treatment began.
Some participants experienced even greater regrowth. Depending on the dose and the trial, between 13 and 22.5 per cent of people taking upadacitinib regained all of the hair on their scalp.
The drug appears to work by blocking immune signals that are involved in the attack on hair follicles. Patients taking the medicine also reported improvements in their quality of life.
The short-term safety results were encouraging, with serious side effects occurring in only a small proportion of participants.
However, the results should still be viewed with some caution. The trials lasted for only 24 weeks, so researchers do not yet know enough about the drug's long-term effects or safety in people with alopecia areata.
The trials were also funded and co-designed by AbbVie, the company that makes upadacitinib, and some of the researchers work for the company. The study was independently peer-reviewed, but further research will be needed to compare the drug with existing alopecia treatments as well as with a placebo.
Overall, the findings suggest that upadacitinib could become a useful treatment for people with severe alopecia areata. The researchers say the speed and extent of hair regrowth seen in the trials make the drug a promising option for patients.
The research has been published in JAMA Dermatology.
