Friday, September 30, 2022

It’s the ‘miracle pill’ against some serious baldness

The oral drug baricitinib (Olumiant, from Lilly) has garnered great hopes, to the point of earning the nickname of the miracle pill because of its good results against alopecia areata. But drug research holds new promise for this and other types of alopecia.

The drug, which has already received approval from both the European Medicines Agency (EMA) and its US counterpart (FDA), is an immunomodulator that comes from the rheumatoid arthritis vedemcum, it is used in covid-19 and more recently A sign of this is atopic dermatitis. In the case of alopecia areata, it was the first Janus kinase (JAK) inhibitor to demonstrate efficacy. These medicines block the activity of a specific family of enzymes that interfere with the pathway that leads to inflammation.

Phase III trial in patients with severe alopecia who had At least 50% hair loss on the scalp For more than six months, show that it is able to achieve at least 80% hair coverage of between 35% and 32% of patients with the 4 mg dose, and approximately 22% and 17% with the 2 mg dose. In these trials, the placebo rate reached 5% and 3%, respectively. Details of the studies have been published The New England Journal of Medicine,

“The acceptance of baricitinib is a milestone in this disease, because it is first specific treatment for this alopecia, and it would provide a very useful therapeutic tool”, explains Sergio Van, Coordinator of the Spanish Trichology Group of the Spanish Academy of Dermatology and Venereology (AEDV) and Director of the Trichology Unit of the Ramón y Cajal Hospital in Madrid. “It is a drug with a favorable effectiveness and safety profile, as shown in clinical trials.”

dermatologist Andrea Combalia, a specialist in trichology at the Barcelona Clinic, admits that “it marks a before and after” for these patients. “Alopecia areata, despite being an autoimmune disease, has been around for many years. The great underdog in drug development”, he explains. “By far, we use corticosteroids, minoxidil and immunosuppressive treatments the most. However, sometimes, in areas of widespread or universal alopecia, we do not achieve complete regrowth or when we do, we do not manage to maintain this repopulation over time”.

Without forgetting the issue of safety: “Treatment with corticosteroids and immunosuppressants has been associated with long-term side effects, and we should always correct risk-benefit assessment, Especially given that this is an autoimmune disease that initially only affects the hair follicles.”

Nor is baricitinib without side effects. In the United States, the drug is referred to as a . is presented with alert box At risk of serious infection, mortality, cancer, major adverse cardiovascular events and thrombosis.

In dermatology, baricitinib is already used in Spain for the treatment of atopic dermatitis, as well as for off-label use in selected patients with alopecia areata. “The advantage of this is that We already know your security profile and how patients should be managed”, Combalia says.

For whom?

One thing to keep in mind when accessing: cost (The price set by Health for atypical dermatitis is around EUR 1,000 per month). The VA understands that if funding is obtained in Spain, the first beneficiaries would be “selected patients”, according to criteria such as severity of alopecia and lack of response to other treatments.

“In principle, it would be indicated for patients who have Pervasive total or universal alopecia areata that has not responded As for previous treatments”, the clinic’s dermatologists abound.

Alopecia areata is a common disease, with an estimated prevalence of between 1% and 2%, taking into account that this definition includes both patients with a small plaque and those with total hair loss. But the eventual availability of an effective treatment can enhance diagnosis and seeking care: “When new therapies arrive, many patients who had not been treated for years return for consultation, in the hope that a treatment will be successful.”

Comballia highlights the importance of receiving better treatment for a disease with a high emotional impact: “To a greater or lesser extent, the quality of life of patients with alopecia areata is always affected,” he warns. “In addition, we know that, in genetically predisposed patients, the presence of alopecia areata linked to stress and anxietyAnd your hair loss spoils this wheel.”

i+d

As with baricitinib, more drugs from the same family are in development for alopecia areata. “Many JAK inhibitor drugs are in the final stages of clinical trials before their potential approval, such as ruxolitinib deuterado and ritlesitinib“With these drugs, many companies are betting on new treatments in alopecia areata, which will lead to new therapeutic tools.”

Of these, the family of sphingosine phosphatase receptor modulators stands out, “in particular, the drug atrassimode,

With regard to research and development into other types of alopecia, VA uses in androgenetic alopecia Minoxidil Oral and SublingualAnd this Dutasteride and Bicalutamide Microinjection,

Finally, in cicatricial alopecia, experts from the Academy of Dermatology outline the use of “ JAK inhibitors for lichen planus pilaris and folliculitis decalvansSimultaneous use of oral minoxidil and platelet-rich plasma”.

One of the most notable recent advances in the pharmacological treatment of alopecia is oral minoxidil for androgenetics: “Its use has increased greatly, with very positive feedback,” says Va.

“You can say that he is time of alopeciaBecause of the progress being made”, Combalia says. “For example, in androgenetic alopecia we have moved from topical treatment with alpha 5 reductase inhibitors to using a number of other therapies and combinations, such as those with alpha 5 reductase inhibitors. with mesotherapy, oral hair growth stimulator or platelet-rich plasma, which Allows us to achieve therapeutic success on multiple occasions and delay the need for a hair transplant.”

alopecia areata

Alopecia areata has been recognized as one of the most urgent types of new effective treatments, which is why “JAK pathway inhibitor drugs are on the way to authentic revolution“Wa says.

Better therapeutic options for alopecia areata are also lacking, dermatologists agree. especially as alopecia frontal fibrosant, says Combalia. “This is a type that we are seeing a lot, whose etiopathogenesis is unclear, and the therapy is not very well defined,” exclaims the dermatologist. “More research is needed to determine what causes this and to be able to offer more therapeutic solutions to patients.”

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Nation World News Desk
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