Publications

BACKGROUND: Frontal fibrosing alopecia (FFA) is a cicatricial alopecia with generally poor prognosis if untreated and no approved treatment options.

OBJECTIVE: The aim of this study was to evaluate changes in the molecular signature of FFA lesions after application of delgocitinib cream. Safety, tolerability, and efficacy were also investigated.

METHODS: This was a phase 2a, randomized, double-blind, exploratory trial of 20 mg/g delgocitinib cream (2%) versus cream vehicle in patients with FFA.

RESULTS: A total of 30 adult females with FFA were randomized to delgocitinib cream (n = 15) or cream vehicle (n = 15). After 12 weeks, expression of the T helper 1-related biomarker CXCL9 was significantly downregulated (-3.10; P < .05), whereas there were nonsignificant reductions in CXCL10 (-2.60; P < .1) and IFN-γ (-1.49; P = .22) in lesions treated with delgocitinib cream but not cream vehicle. Delgocitinib-treated lesions had a small but significant mean improvement in transcriptomic profile (4%; P < .001), whereas lesions treated with cream vehicle worsened (33%). Delgocitinib cream was well-tolerated and associated with improvements in exploratory clinical severity endpoints.

LIMITATIONS: Limitations of the trial include small sample size, biomarker analyses only being conducted to week 12, and the exploratory nature of efficacy endpoints.

CONCLUSION: Delgocitinib cream resulted in an improvement in the transcriptomic profile of lesions and may have potential as a topical treatment for FFA. This study is registered with NCT05332366.

BACKGROUND: Janus kinase inhibitors (JAKis) have transformed the treatment of alopecia areata (AA), but not all patients respond to initial therapy. The utility of switching between JAKis in treatment-refractory AA remains underexplored.

OBJECTIVE: To evaluate the efficacy and safety of switching between JAKis in patients with severe AA.

METHODS: In this multicenter retrospective study, we analyzed 108 patients with severe AA who switched between oral JAKis after a minimum treatment duration of 6 months. Treatment response was assessed using the Severity of Alopecia Tool (SALT). Multivariable logistic regression was used to identify predictors of response to a second JAKi.

RESULTS: Overall, 48.8% of patients achieved SALT ≤20 on their second JAKi, and 32.6% achieved SALT ≤10. Of 21 patients who received a third JAKi, 52.4% achieved SALT ≤20 and 38.1% achieved SALT ≤10. Patients who responded to their first JAKi were more likely to respond to a second (odds ratio, 3.33; 95% CI, 1.22-9.68; P = .022). Adverse events were mild and consistent with prior reports.

LIMITATIONS: Retrospective design, treatment heterogeneity, and potential selection bias.

CONCLUSIONS: Switching between JAKis appears to be a viable strategy for severe AA patients, especially those responding to prior JAKi. Prior response may help guide treatment sequencing.

INTRODUCTION: Alopecia treatments can incur significant patient costs; however, this monetary impact has yet to be characterized in scarring alopecia (SA) patients. Our study aims to characterize the financial burden of SA and its psychosocial impact.

METHODS: We conducted a cross-sectional study using survey data collected by the Scarring Alopecia Foundation between December 2, 2022, and December 16, 2022. Financial burden metrics and quality of life impacts were analyzed using RStudio.

RESULTS: A total of 1,047 individuals (97.4% female, mean age 57.8 years) completed the survey. Most patients (51.4%) spent USD 1-100 monthly on medical treatments, followed by USD 101-250 (22.8%). Annual costs for nonprescription treatments were most commonly <USD 100 (37%), followed by USD 101-500 (26.5%). Annual costs for nonmedical items were more evenly distributed, yet nearly one in five patients spent >USD 1,000. No differences were seen between general dermatologist and hair loss specialist patients. Most patients felt only somewhat supported or not supported by insurance with no difference between public and private coverage. Additionally, no financial metrics were significantly associated with differences in quality of life.

CONCLUSION: Regardless of provider type, patients with SA face substantial out-of-pocket costs for nonmedical items with limited insurance support. Further advocacy is needed to lessen the financial burden faced by SA patients.