Treating Alopecia Areata: Where are we at the end of 2020?
Anthony Gilding, Science and Research Communication at CANAAF
Alopecia Areata (AA) was first clinically described in 1817 by Dr. Thomas Bateman as bald patches that were mainly circular. 203 years later, Alopecia Areata is recognized as an autoimmune disorder that causes varying degrees of hair loss, often resulting in bald patches. Alopecia Areata can further be classified into sub-types. Alopecia Areata Monolocularis (aka patchy) results in one or several bald patches. Alopecia Areata Totalis results in complete loss of hair on the scalp and is increasingly being recognized as including loss of eyebrows and eyelashes. Alopecia Areata Universalis results in loss of hair across the entire body. Yet, despite learning so much about Alopecia Areata, we still have more questions than answers. What triggers the onset of the disorder? Why are some hair-bearing areas affected by the disorder, but not others? What can we do to reverse the hair loss and prevent it from coming back? These are all critical questions that need to be answered before we can effectively cure Alopecia Areata.
So, how we do answer these questions? Unfortunately, it is not as simple as searching the internet. As with any disease, the answers to these questions can be elucidated through biomedical research. Yet, up until this point research has demonstrated that Alopecia Areata is scientifically complex and does not appear to fall within one branch of science. Rather, Alopecia Areata intersects with many areas of biomedical science including, but not limited to immunology, genetics & genomics, cell biology, biochemistry, pharmacology, and microbiology. This scientific complexity requires a team approach to research. We need biomedical scientists from all disciplines to help us delineate the inner workings of Alopecia Areata. Coupled with the work of these biomedical scientists are clinical trials, where patients are given newly discovered or repurposed medical interventions to determine their potential efficacy in treating AA.
As of this year, 2020, we know that one of the most effective therapies thus far has been the use of Janus Kinase (JAK) inhibitors, a class of medications that modify the immune system to suppress the autoimmune response. The first JAK inhibitor to be studied in AA was Tofacitinib Citrate, better known by its brand name, Xeljanz. Xeljanz is used primarily for rheumatoid arthritis, another type of autoimmune disease, but its success in regrowing hair has probed researchers to synthesize similar drugs that are more tailored to the specific disease processes identified in AA. This has led to many clinical trials studying JAK inhibitors and related molecules for the treatment of AA. One of the many clinical trials underway is run by CoNCERT Pharmaceuticals’, where they’re investigating their experimental drug CTP-543 (a JAK inhibitor). Arena Pharmaceuticals is running another clinical trial where they’re studying a sphingosine-1-modulator known as etrasimod. Pfizer, another well known pharmaceutical company is also running a clinical trial where they’re studying the long-term use of an experimental drug called PF-06651600. We are hopeful that all of the studies will yield favorable results and bring us one step closer to finding an effective treatment.
