Therapeutic Advances in Alopecia Areata

Brett King, MD, PhD

Associate Professor of Dermatology

Yale University School of Medicine

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Disclosures

• Off-label use of medications will be discussed

• I have received honoraria and/or consulting fees from:Aclaris Therapeutics, Concert Pharmaceuticals, DermavantSciences, Eli Lilly, Pfizer

• I am a clinical trial investigator for:Concert Pharmaceuticals, Eli Lilly, Pfizer

• I am on a speaker bureau for:Pfizer, Regeneron, Sanofi Genzyme

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Alopecia Areata: Treatment

• Intralesional corticosteroids

• Topical corticosteroids

• Topical immunotherapy (e.g. diphenylcyclopropenone, squaric acid)

• Topical minoxidil

• Oral corticosteroids

• Methotrexate

• Cyclosporine

* No reliably effective therapies, especially for severe disease

Strazzulla LC, et al. Alopecia areata: An appraisal of new treatment approaches and overview of current therapies. J Am Acad Dermatol. 2018;78(1):15-24.

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Baseline 2 monthstofacitinib 5 mg BID

5 monthstofa 10 + 5 mg daily

8 monthstofa 10 + 5 mg daily

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Ruxolitinib 20 mg BID

Nat Med. 2014;20(9):1043-9.

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Alopecia Areata: Pathogenesis

Divito SJ, Kupper TS. Nat Med. 2014;20(9):989–90. Based on Xing L, et al. Nat Med. 2014;20(9):1043-9.

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Janus kinase (JAK) family consists of JAK 1, JAK 2, JAK 3, and Tyrosine Kinase 2 Vitiligo

cytokine: IFN-g

JAK 1/2

AA

cytokines:

IL-15, IFN-g

JAK 1/2/3

JAK inhibitorJAK inhibitor

Damsky W, King BA. J Am Acad Dermatol. 2017;76(4):736-744.

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cytokines: IL-4, IL-13

JAK 1/3

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Brittany G. Craiglow, MD, and Brett A. King, MD, PhD

New Haven, Connecticut

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Lucy Y. Liu, MD, and Brett A. King, MD, PhD

New Haven, Connecticut

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JAKi in AA: Clinical Trials

JAK INHIBITOR TARGETROUTE OF ADMINISTRATION PHASE STATUS IDENTIFIER

ATI-501 JAK1/3 oral 2 active, not recruiting NCT03594227

ATI-502 JAK1/3 topical 2 not yet recruiting NCT03759340

baricitinib JAK1/3 oral 2/3 recruiting NCT03570749

CTP-543 JAK1/2 oral 2b/3 not yet recruiting NCT03811912

PF-06651600 JAK3 oral 2b/3 recruiting NCT03732807

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Other Therapeutic Possibilities?

• Apremilast

• Ustekinumab

• Dupilumab

• Fecal transplant

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Other Therapeutic Possibilities : ApremilastNot for Distribution

Other Therapeutic Possibilities: UstekinumabNot for Distribution

Other Therapeutic Possibilities: DupilumabNot for Distribution

Other Therapeutic Possibilities: Fecal TransplantNot for Distribution

The Future of AA Treatment

• JAK inhibitors

• Apremilast

• Ustekinumab

• Dupilumab

• Fecal transplant

• Other?

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Thank you

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