About Alopecia Treatments for Alopecia Areata Future Treatments for Alopecia Areata? Possible Future Treatments for Alopecia Areata: These treatments are currently not available on the NHS, but this may change in the future. Some of these treatments are still being reviewed to assess whether they are appropriate and useful for Alopecia Areata patients. Oral JAK inhibitors Oral JAK inhibitors to treat Alopecia Areata are still being studied. These are treatments that target different parts of the Janus Kinase enzyme family, which are important steps in causing inflammation, including the inflammatory pathways that occur in active Alopecia Areata. Therefore, when these are blocked, inflammation is reduced. There are currently six JAK inhibitors which have been reported to be successful in treating Alopecia Areata. These are: Tofacitinib, Ruxolitinib, Baricitinib, CTP-543, PF-06651600 and PF-06700841. These are tablet medications. Advantages Reports suggest they may be very effective in causing hair regrowth in some patients with very extensive hair loss or who have had Alopecia Areata that has been resistant to other treatments over the years. However, we are still awaiting clinical trial results to say for certain. These drugs are generally are well tolerated. Disadvantages These are novel treatments; therefore, we are still trying to understand how effective they are and their side effect profile in the long term. Side effects that have been noted already include nausea, headaches, increase risk of infection (including herpes (cold sore) virus reactivation), anaemia, high cholesterol and potentially increase risk of blood clots. There are reports of relapse following discontinuation of this treatment. Topical JAK inhibitors Topical JAK inhibitors to treat Alopecia Areata are still being studied. Current studies have shown that topical JAK inhibitors have not shown satisfactory results for scalp hair regrowth; however, have shown some improvement with eyebrow and eyelash regrowth. The two main topical JAK inhibitors that have been tested and have shown some success with eyelash and eyebrow regrowth are Tofacitinib 2% ointment and Ruxolitinib 0.6% cream. Advantages Studies have shown some success with re-growth of eyelash and eyebrow hair. These have been fairly well tolerated with no complications. The application on the skin reduces the risk of side effects compared with the oral form. Disadvantages Poor response on the scalp. Ustekinumab Ustekinumab reduces inflammation by blocking the activity of chemical signalling molecules (called cytokines), specifically interleukin 12 and 23, that trigger inflammation. It is commonly used in psoriasis and Crohn’s disease. It has been shown in a small case series that it can help hair regrowth in moderate to severe Alopecia Areata. It is injected under the skin of the stomach, thighs or upper outer arms. Advantages Initially patients have an injection on week 4 of treatment and after that every 12 weeks. Disadvantages It can increase the risk of serious infections. Patients can experience reactions at the injection site, fatigue, headaches and sinusitis. We do not have sufficient evidence with regards to the efficacy of this treatment for Alopecia Areata. There have also been case reports of patients developing Alopecia Areata during their Ustekinumab injections for other conditions. Ustekinumab is very expensive. Dupilumab Dupilumab is a biologic medication given through a subcutaneous injection (injection under the skin) that works by blocking chemical messengers (also known as cytokines) in the body called interleukin 4 (IL-4) and interleukin-13 (IL-13). It is currently being used to treat atopic eczema on the NHS. One study has shown a significant improvement in Alopecia Totalis following dupilumab treatment whereas another paper reported cases of Alopecia Areata developing shortly after starting dupilumab for their eczema. Therefore, further clinical trials are needed to assess the role of dupilumab in the treatment of Alopecia Areata. Advantages It is an injection every 2 weeks. It is shown to be very well-tolerated with minimal side effects. Disadvantages The main side effect reported is conjunctivitis (inflammation of the eyes) causing redness, itch and discharge. Other side effects reported are headaches, cold sores and eczema around the eyes. Further clinical trials are necessary before this treatment can become routinely available for Alopecia Areata. Dupilumab is classed as a high-cost drug, so very expensive. Apremilast Apremilast is an inhibitor of the phosphodiesterase 4 (PDE4), which reduces inflammation. PDE4 has been found to be expressed in patients suffering with Alopecia Areata. It comes in the form of a pill that is taken daily. It has been approved and used for the treatment psoriasis and Psoriatic Arthritis. A study of the safety and efficacy of Apremilast in patients with moderate to severe Alopecia Areata is currently in progress. There have been variable results reported in the literature up till now, including good hair regrowth and a study showing no treatment response at all. Advantages Good clinical response in some Alopecia Areata patients. Safe and well tolerated. Oral tablet. Disadvantages Further clinical trials are necessary before this treatment can become routinely available in the treatment of Alopecia Areata. The main side effects are diarrhoea, headache, nausea, fatigue and weight loss. BNZ-1 This is an intravenous medication (given through the vein) currently still being tested in clinical trials. BNZ-1 is an inhibitor of inflammatory pathways involving interleukins: IL-2, IL-9, and IL-15. These have been shown to be increased in Alopecia Areata. The idea is for treatment to be given weekly for 3 months to adults diagnosed with moderate to severe alopecia areata. Study results are not available yet. Abatacept Abatacept is a fusion protein of cytotoxic T-lymphocyte associated antigen 4 (CTLA-4). It improves inflammation by reducing the activation signals to the white blood cells. It is currently being used for conditions such as Rheumatoid Arthritis, Juvenile Idiopathic Arthritis, and Psoriatic Arthritis. It is also given as an injection under the skin, consisting of weekly injections for 6 months, with an additional 6 months of follow up. It is still being reviewed in a clinical trial for Alopecia Areata and results are currently pending. The side-effects that have been reported up till now are risk of serious infection, injection-site reaction, sinusitis, headaches, and high blood pressure.