Expert Insights on Deuruxolitinib for Alopecia Areata

Arash Mostaghimi, MD, MPA, MPH | Image Credit: Brigham and Women's Hospital

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, here discusses the development and approval of deuruxolitinib for treating moderate to severe alopecia areata (AA). As a principal investigator in the THRIVE-AA1 and THRIVE-AA2 trials, Mostaghimi emphasized the efficacy of the drug in promoting hair regrowth, including on the scalp, eyebrows, and eyelashes.

Mostaghimi highlighted the significant psychosocial impact of AA, drawing from their personal experience as a parent of a child with the condition. He emphasized the importance of understanding the emotional toll of the disease on patients beyond the physical symptoms.

This transcript has been lightly edited for clarity.

The American Journal of Managed Care^® (AJMC^®): How does the efficacy of deuruxolitinib compare with existing treatment options for alopecia areata?

Mostaghimi: There haven't been head-to-head studies between any of the 3 JAK [Janus kinase] inhibitors approved for AA. Although it's hard to compare between trials, some of the data suggest that the efficacy for deuruxolitinib is equivalent or higher in comparison to baricitinib 2 mg and ritlecitinib at the 8-mg dose. Deuruxolitinib’s efficacy is comparable to the 4-mg dose of baricitinib. A 12-mg dose of deuruxolitinib was investigated in the THRIVE trials and showed greater efficacy than existing treatments, but was not approved.

Beyond efficacy, another factor that is notable for deuruxolitinib is that in some patients, it may work faster than other JAK inhibitors. The duration of time until you begin seeing results and hitting the peak of those results may be faster than the other existing medications. But again, we haven't done head-to-head studies to be definitive.

AJMC: Can you explain the mechanism of action of this drug and its potential impact on patient care?

Mostaghimi: Similar to the 2 other medications currently approved for AA, deuruxolitinib is a JAK inhibitor. Baricitinib is a JAK1/2 inhibitor, ritlecitinib is a JAK3/TEC [tyrosine kinase] inhibitor. Deuruxolitinib is also a JAK1/2 inhibitor, so in terms of mechanism of action it's probably a little bit more similar to baricitinib than it is to ritlecitinib. Although they may have similar mechanisms, even JAK inhibitors with similar mechanisms may work differently for different people, and you can't necessarily translate the specific mechanism of action within the JAK category to whether one drug will work better or less than the others. It's nice to have another option in this category for patients.

AJMC: Your research focuses on AA, and your biography mentions having a daughter with the condition. Can you elaborate on how this personal experience has shaped your research focus and approach to the disease?

Mostaghimi: I think AA, like many other hair loss disorders, is a fascinating disease in that the patients are overall physically well. It doesn't usually burn or itch or hurt, and they have no functional deficits. But what you do have in some patients is profound psychosocial impact with implications for both their personal and professional lives.

There's been many, many studies demonstrating the long-term consequences of this, ranging from reduced sexual quality of life, to workplace impairment, to isolation from peers, and a lot of other challenges that come from feeling comfortable in your own skin and in front of others.

For me, having a daughter with AA, and thinking about those consequences from the perspective of a parent gives me a different perspective on the condition’s impact overall.