Advancing Research on Alopecia Areata Treatment and Epidemiology

Arash Mostaghimi, MD, MPA, MPH

Arash Mostaghimi, MD, MPA, MPH, assistant professor of dermatology, director of the inpatient dermatology consult service, and codirector of the Complex Medical Dermatology Fellowship at Brigham & Women's Hospital, emphasizes the importance of the development and approval of deuruxolitinib for treating moderate to severe alopecia areata. Mostaghimi was a principal investigator in the THRIVE-AA1 and THRIVE-AA2 trials that proved the efficacy of the drug in promoting hair regrowth.

Mostaghimi focuses on the progress made in understanding the epidemiology of alopecia areata and the development of new treatments but acknowledges the current obstacles that remain.

This transcript has been lightly edited for clarity.

Transcript

AJMC^®: What are the biggest challenges in alopecia areata research currently, and what opportunities do you see for future breakthroughs?

Mostaghimi: There are 2 big challenges. One is that while we have a much better understanding of the pathogenesis of alopecia areata than we did a decade ago, or certainly 20 years ago, I think we haven't yet come to a consensus as to whether there's a specific and key pathway, akin to the IL-17/IL-23 pathway that we see in plaque psoriasis, that we can block safely and improve hair across the vast majority of patients.

We do know that many interrelated pathways are involved. We don't quite know what the core or key ones are yet so there's not a clear and specific target that is obvious. As a result, we are still seeing a lot of drugs that are developed for other indications that are being tried in alopecia areata instead of having new drugs that are specifically designed for this disease.

Concurrent with that is that we need outcome measures that measure the impact of this disease and response, particularly for patients with milder disease (<20% scalp hair loss). I would love to see a trial where patients start with 10% or 20% of hair loss and we get them down to 5% or zero. We don't have really a good outcome measure that captures this key clinical outcome. Development of new clinical trial design and outcome measures to enable us to assess these newer treatments would be significantly beneficial and a core part of the infrastructure that's required to move drugs from the theoretical stage into the market for patients to use.

AJMC: Can you elaborate on the specific challenges you see in the current understanding of alopecia areata epidemiology and its clinical impact on patients?

Mostaghimi: We have a much greater understanding of the epidemiology of alopecia areata than we did years ago. Despite this, our epidemiology is at the level where we understand patterns at a population level, but we haven't quite figured out variation between specific patients with regards to disease severity, response to therapy, and risk of relapse.

Other open questions include whether or not earlier and more aggressive treatment of alopecia areata can prevent the development of comorbidities—both psychiatric and otherwise. This is a real-world question that may inform patients on the fence about treatment.

We also don't know necessarily what the best treatment methods would be for patients who have alopecia areata and another disease. For example, for patients with alopecia areata and atopic dermatitis should drugs like dupilumab and upadacitnib be favored over other treatments? If they have mild atopic dermatitis and mild alopecia areata should that qualify them for a systemic therapy?