Alopecia Areata: Late Responses Complicate Definition of JAK Inhibitor Failure
FROM AAD 2024
Time Factor Is Important for Response
“What we are learning is that patients keep getting better over time,” Dr. Sinclair said. Asked specifically how long he would treat a patient before giving up, he acknowledged that he used to consider 6 months adequate, but that he has now changed his mind.
“It might be that even 2 years is too short,” he said, although he conceded that a trial of therapy for this long “might be an issue for third-part payers.”
Asked to comment, Melissa Piliang, MD, chair of the department of dermatology at the Cleveland Clinic, agreed with the principle that early responses are not necessarily predictive of complete response.
“In my clinical experience, 6 months is not long enough to assess response,” she told this news organization. “Some patients have hair growth after 18 months to 2 years” of treatment. Additional studies to identify the characteristics and predictors of late response, she said, “would be very helpful, as would trials allowing multiple therapies to simulate real-world practice.”
Like Dr. Sinclair, Dr. Piliang is interested in the possibility of combining a JAK inhibitor with another therapy aimed specially at promoting hair regrowth.
“Using a secondary therapy to stimulate regrowth as an addition to an anti-inflammatory medicine like a JAK inhibitor might speed up response in some patients,” she speculated. Dr. Sinclair reports financial relationships with more than 30 pharmaceutical companies, including Eli Lilly, the manufacturer of baricitinib. Dr. King reports financial relationships with multiple companies, including Concert Pharmaceuticals (consultant and investigator), the manufacturer of deuruxolitinib. Dr. Piliang reports financial relationships with Eli Lilly, Pfizer, and Proctor & Gamble.
