JAK inhibitors are the hot topic when it comes to alopecia areata. For decades, there have not really been any meaningful new alopecia areata treatments introduced. What was offered thirty years ago is still offered now, with hit and miss results for patients. We wanted to write a summary blog to help you gain an understanding on JAK inhibitors and their potential for alopecia areata.

Firstly, what is a JAK inhibitor and why are they being explored as a treatment option for alopecia areata?

JAK inhibitors are a type of drug that suppress the activity or response of one or more of the Janus Kinase enzymes, also known as JAK1, JAK2, JAK3 and TYK2. JAK enzymes are known contributors to the autoimmune process. In a nutshell, JAK inhibitors could block the inflammatory pathways that occur in active alopecia areata, reducing the inflammation that occurs around the hair follicles and allowing hair to grow once again.

JAK inhibitor drugs are already used for some patients with other conditions including rheumatoid arthritis and eczema. A key player in the journey to JAKs being explored as a treatment option for alopecia areata is Dr Angela M. Christiano, a molecular geneticist in the field of dermatology. In 2009, Dr Christiano and her research team published the discovery of 139 genetic markers linked to alopecia areata. It was expected that genes involved in alopecia areata would also be involved in other skin diseases, but the research team found that genetic markers linked to alopecia had more in common with other types of autoimmune diseases: type 1 diabetes, rheumatoid arthritis and coeliac disease.

When a case study arose of someone with both rheumatoid arthritis (RA) and alopecia areata experiencing hair regrowth after treatment of their RA with a JAK inhibitor, researchers realised that the same inflammatory process may also be of significance to alopecia areata. This led to an explosion of interest in alopecia areata from pharmaceutical companies – ‘About time pharma showed an interest in alopecia areata!’ one might say! Where previously there was little to no interest in alopecia areata, there are now a handful of pharmaceutical companies including Pfizer, Concert, Leo and Lilly, all trying to find the right JAK inhibitor to get those follicles working properly!

What is happening with clinical trials for JAK inhibitors for alopecia areata?

There are lots of stages of research, starting out with basic research and pilot studies before moving into clinical trials. Clinical trials for JAK inhibitors as a treatment for alopecia areata are currently underway across the world with at least 4 pharmaceutical companies.  Clinical trials can be a lengthy process as they need to rigorously test the drugs, first to check they are safe for use and then to see if they are effective, and monitor any side-effects. The first clinical trials started in the USA and the US authorities are already being approached for approval of the drugs for the treatment of alopecia areata.

Some clinical trials are now taking place across Europe, and in the UK in selected clinics such as in London, Brighton and Glasgow. These have finished recruiting patients and we look forward to seeing what the trial results will be.

At Alopecia UK, we have supported a pharmaceutical company with some of the Public and Patient Involvement (PPI) for the trial design. This ensured that patients with alopecia were able to give their thoughts on the study’s design.

Alopecia UK has also linked in with the National Institute for Health Care and Excellence (NICE) to discuss the patient journey. There are many processes that drugs must go through before they can be approved and licensed for use for a particular condition. Costs need to be justified to institutions like the NHS to advocate for why people with alopecia need these treatments. This includes demonstrating the physical, psychological and social impacts of having the condition. As you might imagine, there is a lot of work involved by many organisations before any new treatments are offered to patients.

What information is coming out of current trials?

We think it is fair to say that the results published so far from clinical trials are a bit of a mixed bag. We understand that the drugs seem to work in more people than perhaps any other treatment currently on offer, so a decent success rate, but it does seem to be the similar story of hair loss resuming once a treatment has stopped. This can be distressing if a drug had brought back hair that someone has not had for years. Researchers are exploring giving different doses of drugs and looking at other factors that are involved in the success (or not) of the drugs. There are some people in the trials for whom the drugs have not had any impact so it does look like whilst JAK inhibitor drugs may be a treatment option for some, they won’t be for everyone. JAK inhibitor drugs are certainly not a ‘cure’ for alopecia areata as some newspaper headlines from the last few years have indicated.

Researchers already know that giving topical creams containing JAK inhibitors has so far not worked – and these clinical trials were halted early and closed. Side effects are also being investigated and considered. Again, these can differ from patient to patient.

Can I get JAK inhibitor drugs for my alopecia areata privately?

We are aware that some people are choosing to source JAK inhibitors themselves. Because JAK inhibitors are licensed in the UK for treating rheumatoid arthritis and atopic dermatitis (eczema), some dermatologists are prepared to prescribe JAK inhibitors for patients with alopecia areata ‘off-label’. This can be at a great cost, with some patients paying more than £1,000 a month for the drugs.  We have also heard of some patients purchasing JAK inhibitor drugs from abroad at lower cost and getting a private UK dermatologist to monitor them.

We strongly urge all patients with alopecia areata never to take any medical treatments without proper, and continued, medical supervision.

Is a new treatment option on the horizon for patients with alopecia areata?

Hopefully. Overall, for many, JAK inhibitors are an exciting area of treatment development that gives some hope of a new treatment option to try in the future. We do not know if, or when, these might become available as the pharmaceutical companies will need to present their results and seek approval from the UK regulatory authorities, and they may judge things differently to the European and US regulatory agencies. But we continue to watch with great interest and also to support the work of pharmaceutical companies, and the patients taking part in those trials, as best we can.

It is clear that JAK inhibitors are not going to be a ‘cure’ that will resolve alopecia areata for everyone. It is therefore important that other areas of research are undertaken. Alopecia UK will continue to invest in research projects exploring the causes and looking for potential new treatments for alopecia. JAK inhibitors are one exciting breakthrough, and will teach us a lot, but we hope there will be many more options in the future. You can find out more about how Alopecia UK is furthering its Research aim here

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