Alopecia Areata Risk in Patients With IBD Tied to Anti-TNF Use

Alopecia areata was more likely to develop in patients with inflammatory bowel disease (IBD) who were taking anti-tumor necrosis factor (TNF) at the onset of the condition. | Image Credit: elenabsl - stock.adobe.com

Alopecia areata increased in development among patients with inflammatory bowel disease (IBD) who were on anti–tumor necrosis factor (TNF) therapy at the beginning of onset, according to an article published in Digestive Diseases and Sciences.¹

IBD is classified as a group of chronic gastrointestinal inflammatory disorders mediated by a dysregulated immune response to the gut microbiome on a background of genetic susceptibility. Ulcerative colitis and Crohn disease are the most common forms of IBD that typically result in bloody diarrhea, abdominal pain, and unintended body weight loss.²

Comorbidities associated with IBD are considered classic, emerging, related to lifestyle, or related to treatment.² Some common comorbidities include psoriasis, psoriatic arthritis, psychological disorders, cardiovascular diseases, sexual dysfunction, smoking/alcohol consumption, substance misuse, skin cancer, and lymphoma.

Reports of patients with IBD experiencing hair loss have affected an estimated one-third of the population.¹ Previous research suggests alopecia areata may be linked to immune-mediated diseases and these rates have been found to be higher among individuals with IBD.

The study focused on comparisons between individuals with IBD who developed alopecia areata and those with IBD without alopecia areata symptoms. The severity of IBD determined possible risk factors for alopecia areata, presence of other IMD, and the types of IBD treatment utilized at alopecia emergence.

Lastly, the study authors “examined outcomes following the development of [alopecia areata] including resolution of the condition and association with cessation of potentially offending therapy.”

The retrospective case-controlled study was conducted among patients with IBD who received treatment at either Massachusetts General Hospital or Brigham and Women’s Hospital, as well as the affiliated hospitals associated with them.

There were 59 patients with IBD who developed alopecia areata without having any prior history. The average interval between IBD diagnosis and alopecia development was 11.5 years compared with the 15.4 years of follow-up duration.

The cohort with alopecia (n = 59) and the control cohort (n = 90) had primarily women participants (47.5% vs 53.3%). Similar types of IBD, location, behavior, and prior related surgery were recognized in both groups. Most cases had endoscopic remission or mild disease activity at the time of alopecia areata diagnosis.

Results indicated higher rates of biologic use at the development of alopecia compared with controls (55.9% vs 34.4%; P = .01), especially for anti-TNF use (40.7% vs 20.0%; P = .006). Within the control group, there were higher percentages of individuals not taking any treatment (32.2%) compared with those who developed alopecia areata (11.9%). No differences were identified among partial or complete improvement of alopecia areata between those who stopped or continued IBD therapy (P = .57).

Of 20 patients who took anti-TNF as alopecia areata developed, 45% achieved partial alopecia improvement while 25% had complete resolution. Similarly, the 30 individuals who did not take anti-TNF had partial improvement (53.3%) and complete resolution as well (23.3%; P = .87).

Alternative alopecia interventions did not exude significant differences in alopecia improvement between those who received no intervention, steroid injections, Janus kinase inhibitors, and other methods (P = .45). Patients with severe alopecia areata were less likely to have complete improvement (0% vs 33.3%; P = .01) or any improvement (50% vs 84.9%; P = .02) compared with the nonsevere cohort.

The study focused on alopecia focalis, totalis, or universalis, which may have limited results by failing to consider other causes of hair loss. A portion of the study population did not receive diagnosis confirmation by a dermatologist and relied only on the moderate sample size that may not apply to weaker associations. Overall, study results were unable to investigate switching after discontinuation and could not provide an estimate of alopecia areata prevalence in IBD.

The research determined patients with IBD who developed alopecia areata were more likely to be using an anti-TNF drug during onset than the control cohort who never developed alopecia areata.

“Longitudinal research with larger cohort sizes will be needed to define incidence of alopecia areata in anti-TNF users, and objectively define frequency of occurrence among those using anti-TNF treatment,” concluded study authors.

References

1. Pan Y, Lilly E, Ananthakrishnan AN. Risk factors for the development of and outcomes after diagnosis of autoimmune alopecia areata in patients with inflammatory bowel diseases. Dig Dis Sci. 2024;69:3375-3381. doi:10.1007/s10620-024-08575-7

2. Kuźnicki P, Neubauer K. Emerging comorbidities in inflammatory bowel disease: eating disorders, alcohol and narcotics misuse. J Clin Med. 2021;10(19):4623. doi:10.3390/jcm10194623