Bald People Now Have a New Cure

For many people suffering from severe alopecia areata, who have lived with baldness, or with scalps only sparsely dotted with hair, or with missing eyebrows or lashes, there is new hope on the horizon for a possible cure. "There’s this unbelievable momentum," Brett King, MD, an associate professor of dermatology at the Yale University School of Medicine in New Haven, CT, said during a recent webinar hosted by the National Alopecia Areata Foundation. Much of that momentum comes from the first oral drug Baricitinib that has been approved by the FDA for severe alopecia areata. Severe disease is marked by at least 50% hair loss.

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Baricitinib – A New Drug for Baldness

Baricitinib is made by Eli Lilly and is part of the Janus kinase (JAK) inhibitor class. Two other JAK inhibitors for the condition (one from Pfizer and another from Concert Pharmaceuticals) are seeing promising results in phase III of clinical trials and may not be far from approval as well, he said.

Baricitinib was approved last month by the FDA, and patients will be able to get it soon as a prescription drug.

It had been approved previously for rheumatoid arthritis patients. It was then tested in clinical trials with alopecia areata patients who had at least 50% hair loss.

King is a pioneer in the use of JAK inhibitors in treating the condition, and he has led multiple clinical trials to test their effectiveness.

With alopecia areata, which affects up to nearly 7 million people in the US each year, the body attacks its own hair follicles, for reasons just beginning to be understood. JAK inhibitors can help interrupt that cycle.

What hasn’t worked in clinical trials is topical JAK inhibitors, King says, though some patients who are referred to him spend up to $400 a month on those treatments.

"It’s terrible," he said. "There is no data that says that topical JAK inhibitors are effective for severe alopecia areata."

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Will Baricitinib Work for All?

Baricitinib provides hope to many but may not be the end cure for all the patient who suffer from baldness. King said that oral JAK inhibitors don’t work for everyone with severe hair loss, and answers are few as to why that is.

"One of the reasons some people don’t succeed is because their hair loss has been severe for too long. And we think that approaching 10 years or longer often, not always, often carries a poor prognosis," he said.

"This is an important thing for everybody to hear," he said. "We don’t want severe hair loss to go on for too long before we treat it. So that the hair follicles remain viable."

Drawing attention to the seriousness of the disease from insurers and others has been difficult because to some, it’s just hair loss. But patients and their health care teams know the extent of the psychological toll.

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Will Smith’s Slap and Alopecia

Have you read about the reason behind ’the slap’ episode that rocked the Oscars ceremony this year. Will Smith during the ceremony slapped the host Chris Rock who joked about the smooth scalp of Will Smith’s wife Jada Pinkett Smith. Jada has been vocal about her struggles with alopecia areata in recent years. The joke brought Smith out of his seat and up on the stage and in a rage, he just slapped the host for touching on such a sensitive personal topic.

Baricitinib Will Help with the Unmet Need for Cure of Baldness

: Until June, treatments were limited to steroid shots in the scalp, which was mostly used for mild alopecia areata, but sometimes for more severe disease. King said that it could involve dozens of needle sticks in the hairless patches, which were painful and not very effective.

The other options for the severe disease were systemic corticosteroids, but they vary in effectiveness, he said. Now, patients have heard the news about the approved oral treatment and have been calling and emailing dermatologists.

"I’ve had several people reach out about it. People are aware of this approval and they’re interested. It’s a big unmet need for treating this condition," Benjamin Ungar, MD, a dermatologist with the Alopecia Center of Excellence at Mount Sinai in New York City, says about baricitinib.

Is the Cure With Baricitinib Instantaneous?

Ungar says that managing expectations for hair regrowth is important. With other inflammatory skin conditions, new drugs may start working right away. It might take some time.

“That is not the case for alopecia areata,” he says, noting that seeing regrowth with baricitinib could take months.

Also, the expectation is that “based on the studies we’ve seen, the treatment needs to be continued to maintain the response,” he notes. If you stop the treatment, the hair will likely fall out again.

Natasha A. Mesinkovska, MD, an investigator in the clinical trials that led to FDA approval of baricitinib and the chief scientific officer at the National Alopecia Areata Foundation, said that patients with the condition may get added benefit from baricitinib for other issues they are dealing with, such arthritis or allergies, that may respond to JAK inhibitors.

“About 30% to 50% with alopecia areata, depending on age group or part of the world, will have allergies, which may be helped” with baricitinib, she says.

Patients on baricitinib will need to come into their dermatologist’s office about every 3 months after they start taking the drug for monitoring tests.

She also said that the risks and benefits will be different for each patient. Patients should talk with their dermatologist about all the risks and about the black box warning on the medication. The main warnings listed are increased risk of serious infection, death, cancer, and major cardiovascular events such as heart attacks and blood clots.

“I can tell you that these events happen at an exceedingly low rate in clinical trials,” King said.

He pointed out that all JAK inhibitors have the black box warning whether used in gastroenterology, rheumatology, or dermatology. Still, it is important to discuss your problem with your dermatologist if you have decided to take baricitinib.

Frequently Asked Questions About Baricitinib

More than 600 questions were sent to the foundation before and during the webinar, as told by Lisa Anderson, research director for the National Alopecia Areata Foundation.

Below are a few questions that King answered during the webinar, edited for length and clarity:

1. Can you get a prescription for baricitinib from a general practitioner?
A dermatologist should give the prescription for baricitinib, because severe skin disease should be managed by a specialist. A dermatologist will better understand the risks and benefits for individual patients and how to monitor progress.

2. What if your dermatologist isn’t familiar with the baricitinib or doesn’t plan to use it?
Advocate for yourself. If getting your hair back is important to you, ask for a referral to someone who is open to adding the drug baricitinib to your care. If someone tells you that you don’t qualify for the medication, they at least owe you a reason why.

3. Now that baricitinib has been approved, do you recommend switching to that medication from tofacitinib, which has been used off-label to treat alopecia areata?
That needs to be a discussion with your dermatologist. That s a reasonable request because insurance reimbursement is so often denied for tofacitinib. But there is no data on switching, so weigh pros and cons with your dermatologist. Baricitinib will likely be covered by insurance because of the FDA approval.

4. Should you take baricitinib when you’re pregnant or if breastfeeding?
You should not take baricitinib if pregnant or if breastfeeding. King described that the future in light of the first FDA-approved treatment and the promise of more soon: "Truly, we’re going from an endless history of nothing to something, but it’s still the first step. These are enormous advancements."

Source-Medindia