Recent current events have brought renewed awareness of alopecia. Read the latest updates on alopecia treatment and prevalence in patients with long COVID presented at the American Academy of Dermatology (AAD), held from March 25 to 29, 2022 in Boston, Massachusetts.

Baricitinib Achieves Hair Regrowth in Alopecia Areata

Baricitinib treatment showed efficacy across groups of patients with severe and very severe alopecia areata as well as alopecia universalis, according to data by King et al presented at AAD 2022.1

The 2 multicenter, randomized, double-blind, placebo-controlled, adaptive phase 2/3 studies examined the safety and efficacy of baricitinib in 1200 patients with alopecia areata who had 50% or more hair loss. At 36 weeks, the proportion of patients achieving the primary endpoint of Severity of Alopecia Tool (SALT) score of 20 or less was significantly greater among patients treated with baricitinib 2 mg or 4 mg than those given placebo (Table).


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Table. Proportion of Patients With Alopecia Achieving Hair Regrowtha

Disease SubtypeBaricitinib 2 mgBaricitinib 2 mgPlacebo
Severe alopecia32.7% (P <.001)47.6% (P <.001)7.8%
Very severe alopecia9.8% (P <.001)21.3% (P <.001)0.6%
Alopecia universalis19.6% (P <.001)27.7% (P <.001)2.9%
SALT, Severity of Alopecia Tool
aDefined as Severity SALT score ≤20

Disclosure: This research was supported by Eli Lilly and Company. Please see the original reference for a full list of disclosures

Ritlecitinib Achieves Early Response Rates for Alopecia Areata

Ritlecitinib dosages of 30 mg and 50 mg daily had sustained efficacy through 48 weeks for the treatment of alopecia areata with response rates achieved by weeks 8 to 12 of treatment, according to data presented by Natasha Mesinkovska, MD, PhD, and colleagues at AAD 2022.2

The ALLEGRO study was an international, randomized, double-blind, placebo-controlled, combined dose-ranging phase 2b/3 clinical trial. Patients aged 12 years and older with alopecia areata and 50% or greater scalp hair loss were randomly assigned to receive regimens comprising 4 weeks of loading dose, 20 weeks of maintenance therapy, and 24 weeks of extension with dosing: 200/50/50 mg ritlecitinib (n=132), 200/30/30 mg ritlecitinib (n=130), 50/50/50 mg ritlecitinib (n=130), 30/30/30 mg ritlecitinib (n=132), 10/10/10 mg ritlecitinib (n=63), placebo/placebo/50 mg ritlecitinib with a 4-week 200 mg load dose (n=65), or placebo/placebo/50 mg ritlecitinib (n=66). The study endpoints were SALT and Patient’s Global Impression of Change (PCI-C) scores.

At week 24, significantly more ritlecitinib recipients, except for those in the 10-mg treatment arm, achieved a SALT score of 20 or less or 10 or less compared with placebo (all P <.003). Treatment response (SALT score ≤20) was observed as early as week 8 among 200/50/50 mg (P =.008), week 12 among 200/30/30 mg (P =.010), and week 18 among 50/50/50 mg (P <.001) and 30/30/30 mg (P =.008) dose recipients.

Patients in the 200/50/50, 200/30/30, 50/50/50, and 30/30/30 mg cohorts reported PGI-C responses at week 24, which remained stable through week 48. At week 24, eyebrow or eyelash assessments improved and remained stable through week 48 among the ritlecitinib recipients, except for the 10 mg dose, compared with patients given placebo (all P <.05).

Up to week 24, 69% to 75% of patients reported adverse events, most commonly headaches, nasopharyngitis, and upper respiratory infections. Serious adverse events were observed in 0.8% to 3.2% of patients. The safety profile up to week 48 was similar to the placebo-controlled portion of the study.

Disclosure: Multiple authors declared affiliations with the pharmaceutical industry. Please refer to the original article for a full list of disclosures.

Alopecia Is the Most Common Skin Manifestation of Long COVID

Cases of alopecia and other cutaneous lesions persisting after COVID-19 infection were identified in a systematic literature review presented by Abhinav Grover, MD, MS, and colleagues at AAD 2022.3

Skin lesions have been reported in some cases of COVID-19 infection, and some patients experience persistent cutaneous symptoms and pathological manifestations for several months after initial COVID-19 diagnosis or symptom resolution. To characterize the cutaneous manifestations of long COVID, the researchers reviewed peer-reviewed studies that documented persistent skin lesions after the initial COVID-19 diagnosis or resolution of symptoms. The literature search included studies published until May 1, 2021.

The most common skin lesion reported was alopecia, which occurred in 83% of patients with long COVID. Other findings included pernio-like (4.2%), maculopapular (1.7%), urticarial (0.8%), vesicular (0.4%), papulosquamous (0.4%), purpuric (0.4%), and other lesions (2.6%; 1 Kawasaki-like, 1 cheilitis, 1 sarcoid granuloma, 1 onychomadesis, and 1 orange nail lesion).

References

1. Taylor SC, Korman NJ, Tsai T-F, et al. Efficacy of baricitinib in patients with varying degrees of alopecia areata severity: Results from BRAVE-AA1 and BRAVE-AA2. Presented at: the 2022 AAD Annual Meeting; March 25-29, 2022. Abstract/Poster 33766.

2. Mesinkovska N, Shapiro J, King B, et al. Efficacy of the oral JAK3/TEC inhibitor ritlecitinib (PF-06651600) in patients with alopecia areata over 48 weeks: results from the ALLEGRP Phase 2b/3 randomized, double-blind, placebo-controlled trial. Presented at: the 2022 Annual Meeting; March 25-29, 2022. Abstract/Poster 33183.

3. Grover A, Choi F, Pei-Wang S. Long term cutaneous manifestations in COVID-19 patients: a systematic review. Presented at: the 2022 AAD Annual Meeting; March 25-29, 2022. Abstract/Poster 33624.