A Repurposed Drug for a Stubborn Condition

A medication long used to treat rheumatoid arthritis and other inflammatory diseases may offer a new option for people with severe alopecia areata, according to clinical trial results published in JAMA Dermatology. The findings, reported by Medical News Today and several other outlets, suggest that upadacitinib, sold under the brand name Rinvoq, can prompt substantial hair regrowth in patients who have lost at least half of the hair on their scalp.

Alopecia areata is an autoimmune disorder in which the immune system mistakenly attacks hair follicles, leading to patchy hair loss that can progress to extensive scalp baldness and loss of eyebrows and eyelashes. The National Alopecia Areata Foundation estimates that the condition affects roughly 7 million Americans, while Medical News Today cites a global figure of about 160 million people living with the disease. There is currently no cure, and existing treatments include corticosteroids, immunotherapy, and other JAK inhibitors.

What the Trials Found

The Phase 3 clinical program enrolled nearly 1,400 adults and adolescents with severe alopecia areata, as reported by al.com and MassLive. The Times of India specifies the number as 1,399. Participants received either a 15-milligram daily dose of upadacitinib, a 30-milligram dose, or a placebo. The primary endpoint was achieving at least 80% scalp coverage after 24 weeks of treatment.

Results were consistent across reports. About 45% of patients on the 15-milligram dose reached the primary target, while approximately 55% of those on the higher dose did the same, according to al.com and MassLive. Medical News Today reports that about half on the lower dose and 54% on the higher dose achieved the same result. The Times of India says almost half on the lower dose and more than half on the higher dose reached that level, while only around 2% of placebo patients did. Complete scalp regrowth was reported in roughly 13% to 23% of patients at 24 weeks, depending on dosage, according to MassLive. The Times of India adds that more than a third of those on the lower dose and nearly half on the higher dose achieved at least 90% scalp coverage.

Improvements were not limited to the scalp. Some participants experienced better eyebrow and eyelash growth, as noted by MassLive, Medical News Today, and The Times of India. The Times of India also reports that responses continued to improve through one year of treatment.

How the Drug Works

Upadacitinib is a Janus kinase (JAK) inhibitor, a class of drugs that blocks enzymes involved in immune signaling. By interfering with this pathway, the drug appears to stop the immune attack on hair follicles, according to al.com and MassLive. The medication is already approved by the U.S. Food and Drug Administration for rheumatoid arthritis, Crohn's disease, and ulcerative colitis, and is also used for atopic dermatitis, as noted by Medical News Today.

The drug is currently under FDA review as a potential treatment for severe alopecia areata, and it has already been approved in the European Union for this condition, according to MassLive and Medical News Today.

Expert Perspectives

Medical News Today quotes Arash Mostaghimi, MD, MPH, vice chair of clinical trials and innovation in the Department of Dermatology at Brigham and Women's Hospital and associate professor at Harvard Medical School, who is the first author of the study. Mostaghimi described alopecia areata as "an autoimmune condition causing hair loss that carries a profound psychosocial burden for patients" and noted that "many individuals still do not respond sufficiently to existing therapies." He said developing new medications is "critical to expanding effective options for these patients."

The same article includes comments from Joseph W. Fakhoury, MD, a dermatologist at Henry Ford Hospital and a spokesdoctor for the National Alopecia Areata Foundation, who said the results are encouraging.

Considerations and Caveats

The Times of India emphasizes that upadacitinib is not a treatment for common hair thinning or receding hairlines, which have different causes. Side effects reported during the trials included acne, colds, and upper respiratory infections, according to the same outlet. The Times of India also warns against misuse of the drug, stressing that it should only be used under medical supervision.

While the results are promising, the drug's approval status in the U.S. remains pending. As reported by MassLive, upadacitinib is under FDA review for severe alopecia areata, and the European approval came earlier this year.