Transcript: Predictors of treatment response for alopecia areata

Declaration of sponsorship Pfizer

Last updated:2nd Apr 2024

Published:2nd Apr 2024

Dr Brittany Craiglow

Interview recorded Mar 2024. All transcripts are created from interview footage and directly reflect the content of the interview at the time. The content is that of the speaker and is not adjusted by Medthority.

You know, it's really exciting to have approved treatments. And with the clinical trials we've actually learned a lot about patients and who may be more or less apt to respond to therapy. So we've learned, particularly from the baricitinib clinical trials, that patients who have more longstanding disease, so in alopecia areata, just to step back for a minute, there are kind of a couple of lengths of time that we think about in terms of their disease. So one length of time is how long it's been since they got their first patch. But as we know, in many patients, alopecia areata kind of waxes and wanes. And so what we actually care more about is how long it has been since they've had any meaningful scalp hair. So for those very severe patients, we call that the duration of their current episode. So how long has it been, you know, how long have they really not had any hair or almost no hair?

And why we care about that is that we're learning actually that that length of time does influence treatment response. So from baricitinib data, that number looks to be around four years of sort of a cutoff, where after four years of complete or near-complete loss, patients' chance of responding really starts to decrease. The ritlecitinib data, that numbers looks around three and a half years, so we're kind of in that same ballpark. So this is actually really, really important when thinking about treating patients. It's an argument for getting patients on treatment early. You know, there are some patients who say, "Oh, well, you know, maybe I'll wait and see. These drugs are newer," but we know that some patients, you know, they may actually lose their window of opportunity if we don't treat them, you know, early. And this is not to say that patients who have a duration of their current episode longer than four years don't respond, it's just that their chance really does start to decrease over time. So that duration of current episode is really important. And then another thing that's very important is severity of disease.

So, you know, when we look at patients with alopecia areata in the clinical trials, all of them had to have at least 50% hair loss. But when you break those groups down into patients who have 50 to 94% hair loss versus 95 to 100% hair loss, we actually see a pretty big difference in the number of patients who respond to treatment. And so the patients with the severe disease, 50 to 94% versus very severe, 95 to 100% loss, they actually respond quite a bit better than the patients who have very severe loss. So again, this is another argument to think about treating earlier rather than later. Intervening when the disease, you know, is happening, but it's not gotten so severe that the patient's gonna have a harder time regrowing. So those are two, you know, really important takeaways that we've learned from clinical trials. And then for sure, also in medications where there are dose, you know, choices. For example, baricitinib, there's a two milligramme and four milligramme dose. This is kind of intuitive, but the four milligramme dose tends to work quite a bit better. So patients, especially with severe disease, really should be started on the four milligrammes to have the best chance of responding.

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