20 Oct Alopecia Areata: Humira May Improve, or Worsen, Hair Loss
MedicalResearch.com Interview with
Marie C. Leger, MD, PhD
Ronald O. Perelman Department of Dermatology
New York University School of Medicine, New York
Medical Research: What are the main findings of the study? What was most surprising about the results?
Dr. Leger: Alopecia areata is a T-cell mediated autoimmune disease. As such, there was initially hope that inhibiting the helper T cell cytokine TNF-α could effectively treat this condition. This has not been shown to be the case—in fact, one open-label study of etanercept in 17 patients with moderate to severe alopecia showed no hair regrowth and even worsening of alopecia in several subjects. There have been many other case reports in the dermatologic literature of TNF-α inhibitors causing alopecia areata. In contrast, our case report presents a patient who very clearly grew hair on adalimumab—its strength lies in the fact that her hair loss and regrowth were replicated on withdrawal and rechallenge with the medication.
Our patient’s paradoxical response to adalimumab complements other literature suggesting that there are genetic variations in the way a patient’s immune system responds to TNF-α inhibitors. In different individuals, these medications can either treat or cause conditions such as psoriasis or lupus. It seems that this is also the case with alopecia areata.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Leger: Our patient suggests that the inflammatory mechanism involved in alopecia areata is complex and can vary on an individual level. It is known that single gene polymorphisms in the TNF-α gene region have been associated with alopecia areata and that genetic polymorphisms can also affect an individual’s response or non-response to therapy. More research is needed to clarify the inflammatory pathways involved in alopecia areata as well as to predict which patients may respond to therapy.
It is notable that our patient also had extensive eczema. Recently it was reported that a patient with plaque psoriasis and alopecia universalis grew hair on the JAK kinase inhibitor tofacitinib. The efficacy of tofacitinib to treat alopecia remains to be established via clinical trials. But could the presence of eczema or psoriasis in a patient predict the way that their immune system responds to biologic therapies?
Medical Research: What should clinicians and patients take away from your report?
Dr. Leger: In a patient who has failed first line treatments for alopecia universalis or who has contraindications to first line therapy it may be worth considering a short trial of adalimumab. Our patient responded very quickly with very impressive regrowth within 2 months of initiating therapy suggesting that an extensive trial may not be necessary. Of course patients and physicians need to understand both the risks of immunosuppressant therapy as well as the possibility that adalimumab may worsen the alopecia.
Citation:
Last Updated on October 21, 2014 by Marie Benz MD FAAD