Insights on the Future Direction of AA Treatment

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, discusses the significance of the development and approval of deuruxolitinib for treating moderate to severe alopecia areata (AA). Mostaghimi played a key role in the THRIVE-AA1 and THRIVE-AA2 trials and demonstrating the effectiveness of deuruxolitinib in stimulating hair growth.

Mostaghimi discusses the direction of AA research and suggests a promising outlook for the development of future treatments.

This transcript has been lightly edited for clarity.

Transcript

The American Journal of Managed Care^® (AJMC^®): You were involved in the THRIVE-AA1 and THRIVE-AA2 trials investigating deuruxolitinib. Can you discuss your specific contributions to these trials and the most significant takeaways from the results?

Mostaghimi: At Brigham & Women's Hospital, we were a site for the phase 2 and 3 studies for deuruxolitinib. As a principal investigator, I enrolled patients in both of these studies and the takeaway from my experience and the overall data from studies is that we have another efficacious treatment for people with moderate to severe alopecia areata. The net result of these studies is that patients demonstrated scalp hair regrowth and eyebrow and eyelash regrowth with concurrent improvement in psychosocial outcomes, which was wonderful to see.

AJMC: How do you envision the results of the THRIVE-AA trials informing future research directions in alopecia areata treatment?

Mostaghimi: I think the more options you have for patients, the more options you have for patients. Deuruxolitinib is an effective treatment that quickly grows hair in many patients and is a great addition to our armamentarium. It’s been a life altering medication for many of my trial patients. In addition, the focus of the THRIVE trials on quantitative eyebrow and eyelash growth gives us great data for patients who see facial hair loss as a concerning part of their disease.

AJMC: What other promising avenues are being explored in alopecia areata research?

Mostaghimi: Deuruxolitinib is a JAK [Janus kinase] inhibitor that provides another option for patients with moderate to severe disease, which is currently defined as 50% hair loss or greater. The safety data for the short term for JAK inhibitors has been positive, particularly among people with alopecia areata. We have limited long-term data on JAK inhibitors in alopecia areata so far, but the data we have so far are reassuring. One thing we do know is that across JAK inhibitors, patients who regrow their hair have a high likelihood of recurrence if the medications are stopped. These should be considered long-term medications.

With regard to new mechanisms, I think identifying a targeted treatment akin to a biologic that is not as ubiquitous as the JAK/STAT pathway may provide better efficacy and long-term safety. These drugs may be able to target key pathways or key cytokines involved in alopecia areata without impacting lipids levels or changing blood counts. In addition, it would be wonderful if they do not elevate thromboembolic risk or carry a black box warning.

The last big category of innovation is a focus on new treatments for patients with less than 50% hair loss. One approach may be to increase the patients who are candidates for JAK inhibitors. Another focus is to create new topical and injectable formulations that have better safety and efficacy profiles than injectable steroids.