1
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Luo X, Ni X, Zhi J, Jiang X, Bai R. Small molecule agents against alopecia: Potential targets and related pathways. Eur J Med Chem 2024; 276:116666. [PMID: 39002436 DOI: 10.1016/j.ejmech.2024.116666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/28/2024] [Accepted: 07/08/2024] [Indexed: 07/15/2024]
Abstract
Alopecia has emerged as a global concern, extending beyond the middle-aged and elderly population and increasingly affecting younger individuals. Despite its growing prevalence, the treatment options and effective drugs for alopecia remain limited due to the incomplete understanding of its underlying mechanisms. Therefore, it is urgent to explore the pathogenesis of alopecia and discover novel and safer therapeutic agents. This review provided an overview of the prevailing clinical disorders of alopecia, and the key pathways and targets involved in hair growth process. Additionally, it discusses FDA-approved drugs and clinical candidates for the treatment of alopecia, and explores small molecule compounds with anti-alopecia potential in the drug discovery phase. These endeavors are expected to provide researchers with valuable scientific insights and practical information for anti-alopecia drug discovery.
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Affiliation(s)
- Xinyu Luo
- School of Pharmacy, Hangzhou Normal University, Hangzhou, 311121, PR China; Key Laboratory of Elemene Class Anti-tumor Chinese Medicines, Engineering Laboratory of Development and Application of Traditional Chinese Medicines, Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou, 311121, PR China
| | - Xinhua Ni
- School of Pharmacy, Hangzhou Normal University, Hangzhou, 311121, PR China; Key Laboratory of Elemene Class Anti-tumor Chinese Medicines, Engineering Laboratory of Development and Application of Traditional Chinese Medicines, Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou, 311121, PR China
| | - Jia Zhi
- School of Pharmacy, Hangzhou Normal University, Hangzhou, 311121, PR China; Key Laboratory of Elemene Class Anti-tumor Chinese Medicines, Engineering Laboratory of Development and Application of Traditional Chinese Medicines, Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou, 311121, PR China
| | - Xiaoying Jiang
- School of Pharmacy, Hangzhou Normal University, Hangzhou, 311121, PR China; Key Laboratory of Elemene Class Anti-tumor Chinese Medicines, Engineering Laboratory of Development and Application of Traditional Chinese Medicines, Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou, 311121, PR China
| | - Renren Bai
- School of Pharmacy, Hangzhou Normal University, Hangzhou, 311121, PR China; Key Laboratory of Elemene Class Anti-tumor Chinese Medicines, Engineering Laboratory of Development and Application of Traditional Chinese Medicines, Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou, 311121, PR China.
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2
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Kazmi A, Moussa A, Bokhari L, Bhoyrul B, Joseph S, Chitreddy V, Eisman S, Meah N, Sinclair R. Switching between tofacitinib and baricitinib in alopecia areata: A review of clinical response. J Am Acad Dermatol 2023; 89:1248-1250. [PMID: 37024053 DOI: 10.1016/j.jaad.2023.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 02/08/2023] [Accepted: 03/02/2023] [Indexed: 04/07/2023]
Affiliation(s)
- Ahmed Kazmi
- Sinclair Dermatology, East Melbourne, Victoria, Australia.
| | - Anthony Moussa
- Sinclair Dermatology, East Melbourne, Victoria, Australia
| | - Laita Bokhari
- Sinclair Dermatology, East Melbourne, Victoria, Australia
| | - Bevin Bhoyrul
- Sinclair Dermatology, East Melbourne, Victoria, Australia
| | - Shobha Joseph
- Sinclair Dermatology, East Melbourne, Victoria, Australia
| | | | | | - Nekma Meah
- St Helens and Knowsley Teaching Hospitals NHS Trust, Liverpool, England
| | - Rodney Sinclair
- Sinclair Dermatology, East Melbourne, Victoria, Australia; The University of Melbourne, Melbourne, Victoria, Australia
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3
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Miot HA, Criado PR, de Castro CCS, Ianhez M, Talhari C, Ramos PM. JAK-STAT pathway inhibitors in dermatology. An Bras Dermatol 2023; 98:656-677. [PMID: 37230920 PMCID: PMC10404561 DOI: 10.1016/j.abd.2023.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 05/27/2023] Open
Abstract
The JAK-STAT signaling pathway mediates important cellular processes such as immune response, carcinogenesis, cell differentiation, division and death. Therefore, drugs that interfere with different JAK-STAT signaling patterns have potential indications for various medical conditions. The main dermatological targets of JAK-STAT pathway inhibitors are inflammatory or autoimmune diseases such as psoriasis, vitiligo, atopic dermatitis and alopecia areata; however, several dermatoses are under investigation to expand this list of indications. As JAK-STAT pathway inhibitors should gradually occupy a relevant space in dermatological prescriptions, this review presents the main available drugs, their immunological effects, and their pharmacological characteristics, related to clinical efficacy and safety, aiming to validate the best dermatological practice.
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Affiliation(s)
- Hélio Amante Miot
- Department of Dermatology, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil.
| | - Paulo Ricardo Criado
- Centro Universitário Faculdade de Medicina do ABC, Santo André, SP, Brazil; Faculdade de Ciências Médicas de Santos, Santos, SP, Brazil
| | - Caio César Silva de Castro
- Hospital de Dermatologia Sanitária do Paraná, Curitiba, PR, Brazil; Escola de Medicina, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - Mayra Ianhez
- Department of Tropical Medicine and Dermatology, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - Carolina Talhari
- Department of Dermatology, Universidade do Estado do Amazonas, Manaus, AM, Brazil
| | - Paulo Müller Ramos
- Department of Dermatology, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil
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4
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Xia E, Li SJ, Drake L, Reyes-Hadsall S, Mita C, Drucker AM, Mostaghimi A. An Assessment of Current Clinician-Reported and Patient-Reported Outcome Measures for Alopecia Areata: A Scoping Review. J Invest Dermatol 2023; 143:1133-1137.e12. [PMID: 37115113 DOI: 10.1016/j.jid.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 02/04/2023] [Accepted: 02/13/2023] [Indexed: 04/29/2023]
Abstract
Although progress has been made in developing outcome measures for AA, the use of these measures remains unstandardized. A scoping review was conducted to identify the clinician-reported outcome measures (ClinROMs) and patient-reported outcome measures (PROMs) used in assessing and treating AA, the results of which revealed heterogeneity in AA outcome measures. Of 23 research studies ultimately included, only 2 ClinROMs were used by >15% of studies; likewise, of 110 clinical trials evaluated, numerous outcome instruments were used, but only one ClinROM was used by >5% of trials (Severity of Alopecia Tool). These results suggest the need for consensus and standardization in both research and trial settings.
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Affiliation(s)
- Eric Xia
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Sara J Li
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Lara Drake
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Sophia Reyes-Hadsall
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Carol Mita
- Countway Library, Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron M Drucker
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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5
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Buket Basmanav F, Betz RC. Recent advances in the genetics of alopecia areata. MED GENET-BERLIN 2023; 35:15-22. [PMID: 38835423 PMCID: PMC10842544 DOI: 10.1515/medgen-2023-2004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Alopecia areata (AA) is a common autoimmune-mediated hair loss disorder in humans with an estimated lifetime risk of approximately 2 %. Episodes of hair loss usually begin with isolated hairless patches that may progress to complete hair loss over the entire body. A familial occurrence of AA is well established, with recurrence risks of about 6-8 % in first-degree relatives. AA is a multifactorial disorder involving both environmental and genetic risk factors. Previous research has identified 14 susceptibility loci, most of which implicate genes involved in the immune response. The following review presents a summary of the latest findings from genome-wide association, sequencing and gene expression studies of AA, as well as their contribution to the recent therapeutic developments.
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Affiliation(s)
- F Buket Basmanav
- University of Bonn Institute of Human Genetics, Medical Faculty & University Hospital Bonn Venusberg Campus 1, Gebäude 13 53127 Bonn Deutschland
| | - Regina C Betz
- University of Bonn Institute of Human Genetics, Medical Faculty & University Hospital Bonn Venusberg Campus 1, Gebäude 13 53127 Bonn Deutschland
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6
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Johnston LA, Lu C, Poelman SM. Successful treatment of concomitant alopecia universalis and Crohn’s
disease with upadacitinib: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231160914. [PMID: 36968986 PMCID: PMC10031617 DOI: 10.1177/2050313x231160914] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
Alopecia areata is a non-scarring, autoimmune hair loss disorder that is
associated with inflammatory bowel disease. Alopecia areata and inflammatory
bowel disease may have a common pathogenic mechanism that involves the Janus
kinase/STAT pathway. In addition, there are previous case reports of patients
who developed alopecia areata while on biologic therapies for inflammatory bowel
disease. JAK1 inhibitors are currently undergoing investigation as potential
therapies for Crohn’s disease. Upadacitinib, an oral JAK1 inhibitor, has
demonstrated efficacy in treating Crohn’s disease during phase III clinical
trials. In this case report, we present a 23-year-old man with Crohn’s disease
who previously developed alopecia areata while on adalimumab. He had
near-complete resolution of his alopecia universalis after 7 months of treatment
with upadacitinib while on concurrent ustekinumab for Crohn’s disease, which he
had been taking for 16 months prior to starting upadacitinib. Upadacitinib may
be a beneficial therapy for treating concomitant alopecia areata and Crohn’s
disease.
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Affiliation(s)
- Leah A Johnston
- Health Sciences Centre, Cumming School
of Medicine, University of Calgary, Calgary, AB, Canada
- Leah A Johnston, Health Sciences Centre,
Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW,
Calgary, AB T2N 4N1, Canada.
| | - Cathy Lu
- Health Sciences Centre, Cumming School
of Medicine, University of Calgary, Calgary, AB, Canada
- Division of Gastroenterology,
Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Susan M Poelman
- Health Sciences Centre, Cumming School
of Medicine, University of Calgary, Calgary, AB, Canada
- Beacon Dermatology, Calgary, AB,
Canada
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7
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Fagan N, Doherty GA, Meah N, Sinclair R, Wall D. Cross-specialty identification of the JAK1 inhibitor trial agent filgotinib as a potential therapy for alopecia areata. Br J Dermatol 2023; 188:442-443. [PMID: 36680304 DOI: 10.1093/bjd/ljac103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 11/26/2022] [Indexed: 01/22/2023]
Abstract
First report of alopecia areata responding to the selective JAK1 inhibitor filgotinib. This case is a patient with coinciding Crohn’s disease that had failed multiple biologics. It serves as a real-world example of how shared decision making between physicians can greatly improve patient outcomes. It highlights that sharing patient registry datasets between specialties will have great benefits, for example in repurposing of JAK inhibitors for other conditions.
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Affiliation(s)
| | - Glen A Doherty
- St. Vincent's University Hospital, Dublin, Ireland.,Department of Medicine, University College Dublin, Ireland
| | - Nekma Meah
- St Helens and Knowsley Teaching Hospitals NHS Trust, St Helens, UK.,Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | | | - Dmitri Wall
- Charles Institute of Dermatology, UCD School of Medicine, University College Dublin, Dublin, Ireland.,Hair Restoration Blackrock, Blackrock, Dublin, Ireland
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8
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Asfour L, De Brito M, Al-Janabi A, Haw WWY, Johnson A, Flohr C, Yiu ZZN. Global Guidelines in Dermatology Mapping Project (GUIDEMAP): a systematic review of alopecia areata clinical practice guidelines. Clin Exp Dermatol 2023; 48:100-107. [PMID: 36641755 DOI: 10.1093/ced/llac025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/06/2022] [Accepted: 10/17/2022] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Alopecia areata (AA) is a nonscarring alopecia with an estimated global prevalence of 2% and limited data on the efficacy of current treatment. Clinical practice guidelines (CPGs) provide recommendations based on best available evidence. It is unclear how many AA CPGs are available globally. AIM To systematically search for and identify CPGs on AA and to critically appraise their quality using validated tools. METHODS We performed a literature search to identify CPGs published between October 2014 and April 2021, using the following databases: MEDLINE, Embase, National Institute for Health and Care Excellence (NICE), Guidelines International Network, Emergency Care Research Institute guidelines trust, Australian CPGs, Turning Research Into Practice database and DynaMed. The systematic review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Three critical appraisal tools were used: Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, Lenzer's red flags and United States Institute of Medicine's (IOM) criteria of trustworthiness. RESULTS In total, six AA CPGs from seven manuscripts (one CPG was in two parts published in separate papers) were included. The majority (four of six) of the CPGs focused on treatment. Four CPGs (total of five papers) were in English and two CPGs were only available in the original language (one Russian and one Japanese). All AA CPGs demonstrated low quality in several domains in the AGREE II appraisal, including stakeholder involvement and applicability, with the latter being deemed the worst domain for all CPGs, with an average of 29%. The mean (SD) number of Lenzer's red flags for the included CPGs was 3.4 (1.5) out of a total of 8 possible red flags, while the IOM criteria showed 1.6 (0.8) 'fully met' criteria and 3.1 (1.2) 'not met' out of a total of 9 criteria. CONCLUSION We found a limited number of AA CPGs, all of which had significant methodological deficiencies. We encourage guideline development groups to use validated checklists/tools to develop reliable and trustworthy CPGs.
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Affiliation(s)
- Leila Asfour
- Sinclair Dermatology and Clinical Trials Centre, Melbourne, VIC, Australia
- The Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK
| | - Marianne De Brito
- The Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Ali Al-Janabi
- The Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - William W Y Haw
- The Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | | | - Carsten Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust
- Department of Population Health Sciences, King's College London, London, UK
| | - Zenas Zee Ngai Yiu
- The Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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9
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Ramírez-Marín HA, Tosti A. Emerging drugs for the treatment of alopecia areata. Expert Opin Emerg Drugs 2022; 27:379-387. [PMID: 36408593 DOI: 10.1080/14728214.2022.2149735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Alopecia Areata (AA) is the second most common non-scarring hair loss disorder, with a prevalence of 1 in 1000 and a lifetime incidence of 2% worldwide. Data from a recent American study shows that from 68,121 patients with the diagnosis of AA, 37,995 (55.8%) were prescribed treatment for AA within a year of diagnosis, however there are still no therapies able to induce permanent remission, or treatments that guarantee hair regrowth/remissions in 100% of cases, especially in longstanding/severe AA. Recently, oral baricitinib has been approved for AA, being the first drug approved for this specific indication. AREAS COVERED The current review will provide a summary of current pharmacological approaches and novel therapeutics in development. EXPERT OPINION New and very effective drugs have become available for the treatment of severe AA, and many others are expected soon. However, even new, effective treatments are not effective in all patients and recurrence rates after treatment interruption are high. AA is a systemic disease with important impact on quality of life and should not be considered just as an aesthetic problem. Treatment of the disease should take in account and possibly also address treatment of comorbidities.
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Affiliation(s)
| | - Antonella Tosti
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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10
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Wang Y, Liu T, Li S, Tang S, Lin P, Ding Y, Sun Q, Zhu D, Qiao J, Fang H. Efficacy and safety of baricitinib in patients with refractory alopecia areata. Dermatol Ther 2022; 35:e15845. [PMID: 36124361 PMCID: PMC10078533 DOI: 10.1111/dth.15845] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/02/2022] [Accepted: 09/16/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Yuqian Wang
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Taoming Liu
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Sheng Li
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Shunli Tang
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Peiyi Lin
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Yuwei Ding
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Qingmiao Sun
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Dingxian Zhu
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Jianjun Qiao
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Hong Fang
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
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11
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Basmanav FB, Betz RC. Translational impact of omics studies in alopecia areata: recent advances and future perspectives. Expert Rev Clin Immunol 2022; 18:845-857. [PMID: 35770930 DOI: 10.1080/1744666x.2022.2096590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Alopecia areata (AA) is a non-scarring, hair loss disorder and a common autoimmune-mediated disease with an estimated lifetime risk of about 2%. To date, the treatment of AA is mainly based on suppression or stimulation of the immune response. Genomics and transcriptomics studies generated important insights into the underlying pathophysiology, enabled discovery of molecular disease signatures, which were used in some of the recent clinical trials to monitor drug response and substantiated the consideration of new therapeutic modalities for the treatment of AA such as abatacept, dupilumab, ustekinumab and Janus Kinase (JAK) inhibitors. AREAS COVERED In this review, genomics and transcriptomics studies in AA are discussed in detail with particular emphasis on their past and prospective translational impacts. Microbiome studies are also briefly introduced. EXPERT OPINION The generation of large datasets using the new high-throughput technologies has revolutionized medical research and AA has also benefited from the wave of omics studies. However, the limitations associated with JAK inhibitors and clinical heterogeneity in AA patients underscore the necessity for continuing omics research in AA for discovery of novel therapeutic modalities and development of clinical tools for precision medicine.
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Affiliation(s)
- F Buket Basmanav
- Medical Faculty & University Hospital Bonn, Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - Regina C Betz
- Medical Faculty & University Hospital Bonn, Institute of Human Genetics, University of Bonn, Bonn, Germany
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12
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Zhang W, Li X, Chen B, Zhang J, Torres-Culala KMT, Zhou C. Oral Tofacitinib and Systemic Corticosteroids, Alone or in Combination, in Patients With Moderate-to-Severe Alopecia Areata: A Retrospective Study. Front Med (Lausanne) 2022; 9:891434. [PMID: 35801202 PMCID: PMC9255896 DOI: 10.3389/fmed.2022.891434] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionAlopecia areata (AA) is an autoimmune hair loss mediated by CD8 + T cells. Treatment for moderate-to-severe AA is still challenging. Janus kinase inhibitors, such as tofacitinib, have been recently investigated as a promising treatment option for AA. Evidence on the combination use of oral tofacitinib and systemic corticosteroids (SCs) for AA is still lacking.ObjectiveTo compare the efficacy and safety of monotherapy of oral tofacitinib and SCs, as well as their combination in patients with moderate-to-severe AA.MethodsPatients with moderate-to-severe AA, who have been treated with at least 3 months of monotherapy of tofacitinib or SCs, or in their combination, were included in this study. The efficacy and adverse events of these treatments were retrospectively analyzed.ResultsSixty-one patients with moderate-to-severe AA were included in this study. There were 12 (66.7%) of 18 patients in the SCs group, 12 (60.0%) of 20 patients in the tofacitinib group, and 18 (78.3%) of 23 patients achieved SALT50, with no significant difference among the three groups. The ratio of patients who achieved SALT50 was significantly higher in patients with a short duration of current hair loss episode (≤2 years) than in those with a duration of current hair loss episode (>2 years) in all the three groups. There were 66.7% patients in the SCs group, 35.0% patients in the tofacitinib group, and 56.5% patients in the combined group that showed adverse effects.ConclusionTofacitinib was an effective treatment for patients with moderate-to-severe AA, and it was more tolerated than SCs. A combination of tofacitinib and SCs may have higher efficacy than SCs alone. Efficacy significantly decreased in patients with a current episode of disease for more than 2 years.
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Affiliation(s)
- Wenxin Zhang
- Department of Dermatology, Peking University People’s Hospital, Beijing, China
| | - Xiangqian Li
- Department of Dermatology, Peking University People’s Hospital, Beijing, China
| | - Baifu Chen
- Department of Dermatology, Peking University People’s Hospital, Beijing, China
| | - Jianzhong Zhang
- Department of Dermatology, Peking University People’s Hospital, Beijing, China
| | - Kara Melissa T. Torres-Culala
- Department of Dermatology, Peking University People’s Hospital, Beijing, China
- Department of Dermatology, Jose R. Reyes Memorial Medical Center, Manila, Philippines
| | - Cheng Zhou
- Department of Dermatology, Peking University People’s Hospital, Beijing, China
- *Correspondence: Cheng Zhou,
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13
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Asfour L, Getsos Colla T, Moussa A, Sinclair RD. Concurrent chronic alopecia areata and severe atopic dermatitis successfully treated with upadacitinib. Int J Dermatol 2022; 61:e416-e417. [PMID: 35722925 DOI: 10.1111/ijd.16316] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/31/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Lella Asfour
- Sinclair Dermatology, Melbourne, Victoria, Australia
| | | | | | - Rodney D Sinclair
- Sinclair Dermatology, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
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14
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Bennett M, Moussa A, Sinclair R. Successful treatment of chronic severe alopecia areata with abrocitinib. Australas J Dermatol 2022; 63:274-276. [PMID: 35390171 DOI: 10.1111/ajd.13836] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/01/2022] [Accepted: 03/07/2022] [Indexed: 01/03/2023]
Affiliation(s)
| | | | - Rodney Sinclair
- Sinclair Dermatology, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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15
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Zhao MY, Zhang W, Rao GW. Targeting Janus Kinase (JAK) for Fighting Diseases: The Research of JAK Inhibitor Drugs. Curr Med Chem 2022; 29:5010-5040. [PMID: 35255783 DOI: 10.2174/1568026622666220307124142] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/11/2021] [Accepted: 12/21/2021] [Indexed: 11/22/2022]
Abstract
Janus Kinase (JAK), a nonreceptor protein tyrosine kinase, has emerged as an excellent target through research and development since its discovery in the 1990s. As novel small-molecule targeted drugs, JAK inhibitor drugs have been successfully used in the treatment of rheumatoid arthritis (RA), myofibrosis (MF) and ulcerative colitis (UC). With the gradual development of JAK targets in the market, JAK inhibitors have also received very considerable feedback in the treatment of autoimmune diseases such as atopic dermatitis (AD), Crohn's disease (CD) and graft-versus host disease (GVHD). This article reviews the research progress of JAK inhibitor drugs: introducing the existing JAK inhibitors on the market and some JAK inhibitors in clinical trials currently. In addition, the synthesis of various types of JAK inhibitors were summarized, and the effects of different drug structures on drug inhibition and selectivity.
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Affiliation(s)
- Min-Yan Zhao
- College of Pharmaceutical Science, Zhejiang University of Technology, and Institute of Drug Development & Chemical Biology, Zhejiang University of Technology, Hangzhou 310014, P. R. China
| | - Wen Zhang
- College of Pharmaceutical Science, Zhejiang University of Technology, and Institute of Drug Development & Chemical Biology, Zhejiang University of Technology, Hangzhou 310014, P. R. China
| | - Guo-Wu Rao
- College of Pharmaceutical Science, Zhejiang University of Technology, and Institute of Drug Development & Chemical Biology, Zhejiang University of Technology, Hangzhou 310014, P. R. China
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16
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Zhou C, Li X, Wang C, Zhang J. Alopecia Areata: an Update on Etiopathogenesis, Diagnosis, and Management. Clin Rev Allergy Immunol 2021; 61:403-423. [PMID: 34403083 DOI: 10.1007/s12016-021-08883-0] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2021] [Indexed: 12/11/2022]
Abstract
Alopecia areata (AA) is a common chronic tissue-specific autoimmune disease, resulting in hair loss, that affects up to 2% of the general population. The exact pathobiology of AA has still remained elusive, while the common theory is the collapse of the immune privilege of the hair follicle caused by immunological mechanism. Multiple genetic and environment factors contribute to the pathogenesis of AA. There are several clinical treatments for AA, varying from one or multiple well-defined patches to more diffuse or total hair loss of the scalp (alopecia totalis) or hair loss of the entire body (alopecia universalis). The available treatments for AA, such as corticosteroids and other immunomodulators, minoxidil, and contact immunotherapy, are of limited efficacy with a high risk of adverse effects and high recurrence rates, especially for patients with severe AA. Recent insights into the pathogenesis of AA have led to the development of new treatment strategies, such as Janus kinase (JAK) inhibitors, biologics, and several small molecular agents. In addition, modern therapies for AA, including antihistamines, platelet-rich plasma (PRP) injection, and other novel therapies have been well explored. In this review, we discussed the recent advances in the pathogenesis, diagnosis, and treatment of AA.
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Affiliation(s)
- Cheng Zhou
- Department of Dermatology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China
| | - Xiangqian Li
- Department of Dermatology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China
| | - Chen Wang
- Department of Dermatology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China
| | - Jianzhong Zhang
- Department of Dermatology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China.
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17
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Balakirski G, Novak N. Novel therapies and the potential for a personalized approach to atopic dermatitis. Curr Opin Allergy Clin Immunol 2021; 21:368-377. [PMID: 34074875 DOI: 10.1097/aci.0000000000000759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To provide a cutting-edge overview of recent developments in topical and systemic therapeutic approaches for the treatment of atopic dermatitis (AD). RECENT FINDINGS Growing knowledge about key pathways in AD and stratification of patient's subgroups have set the basis for a new era of targeted topical and systemic therapy in AD.Different aspects have to be considered in the decision process for topical versus systemic therapy. Further on, co-factors from the patient's side as well as the side of the substances determine the choice of a particular drug/drug type.Tailored medicine in AD treatment comprises drugs of the group of small molecules such as topical Janus kinases-signal transducer and activator of transcription (JAK-STAT) inhibitors or phosphodiesterase 4 inhibitors, and JAK-STAT inhibitors for oral use, as well as monoclonal antibodies for subcutaneous use, which target key cytokines or cytokine receptors in AD pathogenesis. SUMMARY The current stepwise treatment approaches, which are settled on basic therapy and structured patient education and gradually expanded depending on the severity of the disease by stronger topical or even systemic measures, will have to be adapted to the rapid development in the therapeutic field, mirrored by an impressive high number of ongoing clinical studies as well as novel drugs at late stages of clinical trials with so far quite promising results.
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Affiliation(s)
- Galina Balakirski
- Department of Dermatology, Allergology and Dermatosurgery, HELIOS University Hospital Wuppertal, University of Witten/Herdecke, Wuppertal
| | - Natalija Novak
- Department of Dermatology and Allergology, University Hospital of Bonn, Bonn, Germany
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18
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19
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Chernyshov PV, Tomas-Aragones L, Finlay AY, Manolache L, Marron SE, Sampogna F, Spillekom-van Koulil S, Pustisek N, Suru A, Evers AWM, Salavastru C, Svensson A, Abeni D, Blome C, Poot F, Jemec GBE, Linder D, Augustin M, Bewley A, Salek SS, Szepietowski JC. Quality of life measurement in alopecia areata. Position statement of the European Academy of Dermatology and Venereology Task Force on Quality of Life and Patient Oriented Outcomes. J Eur Acad Dermatol Venereol 2021; 35:1614-1621. [PMID: 34107093 DOI: 10.1111/jdv.17370] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/28/2021] [Indexed: 12/13/2022]
Abstract
New treatment options may lead to an increased interest in using reliable and sensitive instruments to assess health-related quality of life in people with alopecia areata (AA). The purpose of this paper is to present current knowledge about quality of life assessment in AA. The dermatology-specific Dermatology Life Quality Index (DLQI) was the most widely reported health-related quality of life instrument used in AA. Three AA-specific (Alopecia Areata Symptom Impact Scale, Alopecia Areata Quality of Life Index and Alopecia Areata Patients' Quality of Life) and three hair disease-specific instruments (Hairdex, Scalpdex and 'hair-specific Skindex-29') were identified with a range of content and validation characteristics: there is little evidence yet of the actual use of these measures in AA. Scalpdex is the best-validated hair disease-specific instrument. Further extensive validation is needed for all of the AA-specific instruments. The European Academy of Dermatology and Venereology Task Force on Quality of Life and Patient Oriented Outcomes recommends the use of the dermatology-specific DLQI questionnaire, hair disease-specific Scalpdex and the alopecia areata-specific instruments the Alopecia Areata Symptom Impact Scale or Alopecia Areata Quality of Life Index, despite the limited experience of their use. We hope that new treatment methods will be able to improve both clinical signs and health-related quality of life in patients with AA. In order to assess the outcomes of trials on these new treatment methods, it would be helpful when further development and validation of AA-specific instruments is being encouraged and also conducted.
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Affiliation(s)
- P V Chernyshov
- Department of Dermatology and Venereology, National Medical University, Kiev, Ukraine
| | - L Tomas-Aragones
- Department of Psychology, University of Zaragoza, Zaragoza, Spain
| | - A Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - L Manolache
- Dermatology, Dali Medical, Bucharest, Romania
| | - S E Marron
- Department of Dermatology, Aragon Psychodermatology Research Group (GAI+PD), University Hospital Miguel Servet, Zaragoza, Spain
| | - F Sampogna
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
| | - S Spillekom-van Koulil
- Radboud Institute for Health Sciences, Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - N Pustisek
- Children's Hospital Zagreb, Medical School, University of Zagreb, Zagreb, Croatia
| | - A Suru
- Paediatric Dermatology Discipline, 'Carol Davila' University of Medicine and Pharmacy, Dermatology Research Unit, Colentina Clinical Hospital, Bucharest, Romania
| | - A W M Evers
- Health, Medical, and Neuropsychology unit, Leiden University, Leiden, The Netherlands
| | - C Salavastru
- Department of Paediatric Dermatology, Colentina Clinical Hospital, 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
| | - A Svensson
- Department of Dermatology and Venereology, Skane University Hospital, Malmö, Sweden
| | - D Abeni
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
| | - C Blome
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Poot
- Department of Dermatology, University Hospital Erasme, Brussels, Belgium
| | - G B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health and Medical Sciences Faulty, University of Copenhagen, Copenhagen, Denmark
| | - D Linder
- Unit of Dermatology, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Bewley
- Whipps Cross University Hospital, London, UK.,The Royal London Hospital, London, UK
| | - S S Salek
- School of Life & Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
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20
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Zhang T, Nie Y. Prediction of the Risk of Alopecia Areata Progressing to Alopecia Totalis and Alopecia Universalis: Biomarker Development with Bioinformatics Analysis and Machine Learning. Dermatology 2021; 238:386-396. [PMID: 34004600 DOI: 10.1159/000515764] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/07/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Alopecia areata (AA) is an autoimmune disease typified by nonscarring hair loss with a variable clinical course. Although there is an increased understanding of AA pathogenesis and progress in its treatments, the outcome of AA patients remains unfavorable, especially when they are progressing to the subtypes of alopecia totalis (AT) or alopecia universalis (AU). Thus, identifying biomarkers that reflect the risk of AA progressing to AT or AU could lead to better interventions for AA patients. METHODS In this study, we conducted bioinformatics analyses to select key genes that correlated to AU or AT based on the whole-genome gene expression of 122 human scalp skin biopsy specimens obtained from NCBI-GEO GSE68801. Then, we built a biomarker using 8 different machine learning (ML) algorithms based on the key genes selected by bioinformatics analyses. RESULTS We identified 4 key genes that significantly increased (CD28) or decreased (HOXC13, KRTAP1-3, and GPRC5D) in AA tissues, especially in the subtypes of AT and AU. Besides, the predictive accuracy (area under the curve [AUC] value) of the prediction models for forecasting AA patients progressing to AT/AU models reached 90.7% (87.9%) by logistic regression, 93.8% (79.9%) by classification trees, 100.0% (76.3%) by random forest, 96.9% (76.3%) by support vector machine, 83.5% (79.9%) by K-nearest neighbors, 97.1% (87.3%) by XGBoost, and 93.3% (80.6%) by neural network algorithms for the training (internal validation) cohort. Besides, 2 molecule drugs, azacitidine and anisomycin, were identified by Cmap database. They might have the potential therapeutic effects on AA patients with high risk of progressing to AT/AU. CONCLUSIONS In the present study, we conducted high accuracy models for predicting the risk of AA patients progressing to AT or AU, which may be important in facilitating personalized therapeutic strategies and clinical management for different AA patients.
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Affiliation(s)
- Tao Zhang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,
| | - Yingli Nie
- Department of Dermatology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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21
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Steele L, Lee HL, Maruthappu T, O'Toole EA. The status and outcomes of registered clinical trials for Janus kinase inhibitors in alopecia areata: are unpublished trials being overlooked? Clin Exp Dermatol 2021; 46:1290-1292. [PMID: 33608909 DOI: 10.1111/ced.14615] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 02/15/2021] [Indexed: 01/21/2023]
Abstract
Recent meta-analyses of Janus kinase (JAK) inhibitors in alopecia areata (AA) have excluded trial registries and may thus be subject to publication bias. This study assessed the potential for evidence selection bias and provides an overview of JAK inhibitor trials in AA. A broad search strategy of ClinicalTrials.gov was performed for AA. We also recorded whether results were published on PubMed. There were 26 trials identified, of which 9 were ongoing (mostly oral JAK inhibitors: 8 studies; 89%). Of completed/terminated trials, 4/17 (24%) had terminated prematurely, citing 'inefficacy/futility' or 'sponsor decision'. These were all topical JAK inhibitor trials (4/8, 50% termination rate), with a 0% termination rate (0/9) for oral JAK inhibitor trials. We conclude that topical JAK inhibitors may be less efficacious than has been apparent in the literature to date, with 50% of trials having terminated due to inefficacy/futility or sponsor decision and only one topical JAK inhibitor trial ongoing.
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Affiliation(s)
- L Steele
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Queen Mary University of London, London, UK.,Department of Dermatology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - H L Lee
- Department of Dermatology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - T Maruthappu
- Department of Dermatology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - E A O'Toole
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Queen Mary University of London, London, UK.,Department of Dermatology, The Royal London Hospital, Barts Health NHS Trust, London, UK
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22
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Gupta MK, Lipner SR. Review of Nail Lichen Planus: Epidemiology, Pathogenesis, Diagnosis, and Treatment. Dermatol Clin 2021; 39:221-230. [PMID: 33745635 DOI: 10.1016/j.det.2020.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Nail lichen planus is an inflammatory disorder of the nails with potential for significant cosmetic disfigurement and functional impairment. Nail manifestations may be isolated or appear concurrently with other forms of lichen planus. Longitudinal ridging is the most common clinical finding, but progressive disease may result in irreversible scarring (dorsal pterygium) or permanent nail loss (anonychia). Data on treatment are limited to retrospective studies and case reports. The mainstays of treatment are intralesional and intramuscular corticosteroid injections and oral retinoids. There is a need for randomized controlled trials on nail lichen planus to more rigorously assess efficacy and outcomes.
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Affiliation(s)
- Mohit Kumar Gupta
- State University of New York Downstate College of Medicine, Brooklyn, NY, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, 1305 York Avenue, New York, NY 10021, USA.
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23
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Fagan N, Meah N, York K, Bokhari L, Fletcher G, Chen G, Tobin DJ, Messenger A, Irvine AD, Sinclair R, Wall D. Shedding light on therapeutics in alopecia and their relevance to COVID-19. Clin Dermatol 2020; 39:76-83. [PMID: 33972056 PMCID: PMC7738938 DOI: 10.1016/j.clindermatol.2020.12.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
As of July 9, 2020, there were more than 12 million confirmed cases of coronavirus disease 2019 (COVID-19) across the globe, with more than 550,000 deaths. Many European countries, including Belgium, the United Kingdom, Italy, and Spain, have had the highest numbers of fatalities per capita. This indicates the potential for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus to overwhelm even the most advanced health care systems despite extreme societal interventions. Since its emergence, SARS-CoV-2 has disseminated across the globe, affecting the structure of global societies, infrastructure, and economies. Patients with alopecia are a diverse group who, for various indications, are prescribed a number of antimicrobials and antiandrogen treatments in addition to immunomodulatory therapies such as hydroxychloroquine, oral corticosteroids, and a range of broad immunosuppressants. These drugs are being scrutinized for their capacity to potentially affect SARS-CoV-2 outcomes. We examine these treatments and highlight the critical role that patient registries will play in generating real-world evidence to assess their impact on COVID-19 outcomes.
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Affiliation(s)
- Nicole Fagan
- School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - Nekma Meah
- Sinclair Dermatology, Melbourne, Australia
| | - Katherine York
- Department of Dermatology, Netcare Greenacres Hospital, Port Elizabeth, South Africa
| | | | - Godfrey Fletcher
- National and International Skin Registry Solutions (NISR), Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, Australia
| | - Desmond J Tobin
- The Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
| | - Andrew Messenger
- Department of Dermatology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Alan D Irvine
- Department of Dermatology, Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Dmitri Wall
- National and International Skin Registry Solutions (NISR), Charles Institute of Dermatology, University College Dublin, Dublin, Ireland; Hair Restoration Blackrock, Dublin, Ireland
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24
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Hon KL, Luk DCK, Leung AKC, Ng C, Loo SKF. Childhood Alopecia Areata: An Overview of Treatment and Recent Patents. RECENT PATENTS ON INFLAMMATION & ALLERGY DRUG DISCOVERY 2020; 14:117-132. [PMID: 32723274 DOI: 10.2174/1872213x14999200728145822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/14/2020] [Accepted: 07/23/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Alopecia Areata (AA) is a systemic autoimmune condition that usually starts in childhood. OBJECTIVE This article aims to review genetics, therapy, prognosis, and recent patents for AA. METHODS We used clinical queries and keywords "alopecia areata" AND "childhood" as a search engine. Patents were searched using the key term "alopecia areata" in Patents.google.com and freepatentsonline. com. RESULTS Due to an immune-mediated damage to the hair follicles, hair is lost from the scalp and other areas of the body temporarily or even permanently. Children with AA are generally healthy. Evidence of genetic association and increased predisposition for AA was found by studying families with affected members. Pathophysiologically, T- lymphocytes attack hair follicles and cause inflammation and destruction of the hair follicles and hair loss. In mild cases, there would be well-demarcated round patchy scalp hair loss. The pathognomonic "exclamation mark hairs" may be seen at the lesion periphery. In more severe cases, the hair loss may affect the whole scalp and even the whole body. The clinical course is also variable, which may range from transient episodes of recurrent patchy hair loss to an indolent gradually deteriorating severe hair loss. The treatment of AA depends on factors including patients' age, the extent of the hair loss, duration of disease, psychological impact, availability and side effect profile of the treatments. For localized patchy alopecia, topical application of corticosteroids and/or intralesional corticosteroids are the treatment of choice. Other topical treatments include minoxidil, anthralin, coal tar and immunotherapy. In severe resistant cases, systemic immunosuppressants may be considered. Although herbal medicine, acupuncture, complementary and alternative medicine may be tried on children in some Asian communities, the evidence to support these practices is lacking. To date, only a few recent patents exist in topical treatments, including Il-31, laser and herbal medications. Clinical efficacy is pending for these treatment modalities. CONCLUSION None of the established therapeutic options are curative. However, newer treatment modalities, including excimer laser, interleukin-31 antibodies and biologics, are evolving so that there may be significant advances in treatment in the near future. AA can be psychosocially devastating. It is important to assess the quality of life, degree of anxiety, social phobia and mood of the patients and their families. Psychological support is imperative for those who are adversely affected psychosocially.
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Affiliation(s)
- Kam L Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - David C K Luk
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Kwun Tong, Hong Kong
| | - Alexander K C Leung
- Department of Pediatrics, The University of Calgary and The Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Chantel Ng
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Steven K F Loo
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
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