Alopecia areata Learning Zone
Transcript: AAD 2024 Highlights
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 now the AAD has lots of sessions that cover alopecia areata. We did a whole symposium about alopecia areata and, you know, even five years ago this was kind of unheard of. So this is a disease that's finally getting the attention that it warrants. And I think people are excited about treating it and have questions and 'cause it really, you know, the treatment really is nuanced. You know, it is different from a lot of the things we do in dermatology. So one of the things that we learned was some late breaking data about deuruxolitinib, which is another medication that's been in clinical trials for alopecia areata. It's a JAK1/2 inhibitor that we may see approved, at least in the United States, hopefully in the summer. They have, you know, really great response rates in many of their patients. And so I think, you know, hopefully we're gonna have even another choice. And one thing that's cool and what we've talked about at some of the sessions is that, you know, just because one patient fails one JAK inhibitor doesn't mean they might not respond to another. And so this is something that's kind of interesting as we have choices that we're learning. Now, we still don't know what it is about, you know, one person who makes them more likely to just respond to one than another. But I think moving forward, you know, over time we may be able to identify clinical characteristics or biomarkers or things like that where we could move towards more of a personalised medicine situation, which I think, you know, even five years ago we never thought we'd have approved therapy. So even to be talking about that at this point is really exciting. And you know, there was a lot of talk about ways to kind of boost response to JAK inhibitors.
So many of us who do, you know, take care of a lot of hair loss patients will add oral minoxidil. That's something that tends to have a nice synergy in patients who have, you know, kind of stubborn patches, you know, they've done really well, but they have stubborn patches, using intralesional triamcinolone is another option. And then we learned also a little bit about trajectories of response. So, you know, everybody responds differently. There are patients who kind of grow really quickly and it's incredible. And then there are other patients who take longer. And so with Baricitinib, there's some data sort of showing these three patterns of response. So these early responders who, you know, within a couple of months are really taking off very quickly, patients who are more sort of in the middle, the slow and steady improvement. And then a group of late responders who even by nine months really don't see much, but then they start to regrow. And so perhaps not surprisingly, the early responders tend to be patients with less severe disease and the patients who are late responders tend to be patients who have more severe or more longstanding disease. But this is useful for clinical practise because one of the questions people have now is, if you have somebody who's not regrowing on one of these medications, when do you think about changing, right? And so three months is way too early, right? And so we're learning that probably, you know, at least 9 - 12 months to really give a patient a full trial, especially people who have had longstanding disease and patients who don't have hair regrowth, you know, scalp hair regrowth, but do have eyebrow, eyelash regrowth, those patients may later on start to have hair growth. So, you know, we're kind of at a point now where, okay, we have these medications, but now all these clinical questions are coming up. So a lot of those things were talked about at the AAD. And I think the more we have experience in clinical practise, the more data we have, the better we're gonna get at taking care of these patients.
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