Exploring Comorbidities, Dupilumab Treatment in Pediatric Alopecia Areata

These posters presented at the Society for Pediatric Dermatology meeting offer valuable insights into both the comorbidities associated with AA in children and the potential of dupilumab as a treatment for those with coexisting atopic dermatitis | Image Credit: Nadzeya - stock.adobe.com

Two posters presented at the Society for Pediatric Dermatology Annual Meeting, which took place July 11-July 14, in Toronto, Ontario, Canada, focused on the associated comorbidities in pediatric patients with alopecia areata (AA) and treatment outcomes of patients who received dupilumab.

Alopecia areata is a common autoimmune disease that affects hair follicle growth in both adult and pediatric patients. Around 23.9% of cases are present during childhood, and epidemiological studies have found various disorders in conjunction with AA.¹ Some of these disorders include vitiligo, thyroid diseases, systemic lupus erythematosus, and atopic conditions. Atopic dermatitis has been found to be the most common comorbidity in this patient population.

The first poster¹ was about a retrospective study on the associated comorbidities of patients with AA who were treated at the National Institute of Pediatrics between 2008 to 2018. A total of 105 patients diagnosed with the hair loss condition participated in the study with slightly more women participants than men (56.2% vs 43.8%).

Comorbidities were classified as autoimmune, psychological, inflammatory/reactive, congenital, neoplastic, and infectious. Patients were categorized by extension, age of onset, and response to treatment. Results were analyzed using Chi-square and Mann-Whitney U tests (P ≤ .05 significant).

Most of the patients who participated in the study had comorbidities (90%), the most common being inflammatory disorders (44.7%), congenital diseases (34%), and mental health issues (26.6%). More specifically, allergic rhinitis (11.4%) and atopic dermatitis (10.4%) were identified as common inflammatory disorders. Congenital diseases included Down syndrome, often linked to thyroid disease and present in 40% of the population. The top mental health disorders were anxiety (15.2%) and depression (6.6%).

Localized AA was the most frequent subtype (74.3%) and was linked to more than 50% regrowth in hair, shorter disease duration (P = .02), fewer recurrences (P < .01), and fewer therapeutic modalities (P < .01).

More than half of patients had disease onset in preschool age (53.3%), and this outcome was more common in females with higher rate of recurrences (P = .01).

Data from the poster aligned with a previous study that found strong links to diseases like ocular, thyroid, connective tissue, or autoimmune diseases among patients with AA.²

The second poster shifted focus onto the outcomes dupilumab has on pediatric patients with AA who also have atopic dermatitis.³ Children are significantly affected by AA and atopic dermatitis, both chronic conditions associated with Th2-mediated immune responses that share similar cytokine profiles. The poster included data from a scoping review that included 7 studies with a total of 31 patients at an average age of 11.4 years old.³

According to the GLOBOSTAD study, dupilumab proved its effectiveness for the treatment of atopic dermatitis in both adult and pediatric patients after a clinical assessment found sustainable improvements after 1 year of treatment.⁴

Alopecia universalis was the most common subtype of AA found among the patient population. Additionally, topical and systemic corticosteroids were the most frequently used forms of treatment for both AA and atopic dermatitis for each condition.

This analysis found 77.4% of patients achieved hair regrowth after dupilumab treatment. There was an identifiable reduction in Severity of Alopecia Tool score to 42.6 following dupilumab treatment (P < .01). The average immunoglobin level was 3.0 prior to dupilumab initiation, which decreased to an average of 0.857 (P < .01).

The review findings may be incomplete due to several limitations. These include potential bias, inconsistencies in how data were reported, a limited number of participants, and a short follow-up period. Dupilumab is known to cause AA in some patients with atopic dermatitis. More research is needed to understand specific factors in children, such as age, underlying symptoms, or how soon they start treatment, which influence how well they respond to dupilumab, as well as the length of the positive effects of dupilumab last in these patients.

These posters presented at the Society for Pediatric Dermatology meeting offer valuable insights into both the comorbidities associated with AA in children and the potential of dupilumab as a treatment for those with coexisting atopic dermatitis. However, further research with larger, more robust studies is needed to fully understand the long-term effects of dupilumab and identify potential predictors of treatment response in this population.

References

1. Martinez-Gayosso A, Garcia-Romero MT. Associated comorbidities in pediatric patients with alopecia areata. Presented at: Society for Pediatric Dermatology Annual Meeting; July 11-July 14, 2024; Toronto, Ontario, Canada. Poster 46.

2. Santoro C. Study finds AA associated with connective tissue, ocular diseases and vitamin D deficiency. The American Journal of Managed Care^®. February 9, 2024. Accessed July 23, 2024. https://www.ajmc.com/view/study-finds-aa-associated-with-connective-tissue-ocular-diseases-and-vitamin-d-deficiency

3. Metko D, Mehta S, Sibbald C. Dupilumab for the treatment of alopecia areata in pediatric patients with atopic dermatitis: a scoping review. Presented at: Society for Pediatric Dermatology Annual Meeting; July 11-July 14, 2024; Toronto, Ontario, Canada. Poster 71.

4. McCormick B. Dupilumab considered safe, effective treatment for adolescent, adult patients with AD. AJMC^®. March 20, 2024. Accessed July 23, 2024. https://www.ajmc.com/view/dupilumab-considered-safe-effective-treatment-for-adolescent-adult-patients-with-ad