Patients with alopecia areata are at risk of endothelial dysfunction: results of a case–control study

Waśkiel‐Burnat, Anna; Kotowska, Maja; Dorobek, Wioleta M; Smyk, Julia M; Niemczyk, Anna; Blicharz, Leszek; Filipiak‬, Krzysztof J.; Olszewska, Małgorzata; Rudnicka, Lidia

doi:10.1111/ced.15206

Cited by 7 publications

(10 citation statements)

References 18 publications

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“…Alopecia areata has been considered an organ-specific disorder limited to the hair follicles. However, recent studies have indicated that the disease is associated with systemic dysregulation of cytokines [ 43 ], which leads to the presence of numerous inflammatory and metabolic comorbidities [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

Safety of Janus Kinase inhibitors in Patients with Alopecia Areata: A Systematic Review

2023

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Background and Objectives Janus kinase (JAK) inhibitors are emerging as a therapeutic option for alopecia areata. The risk of potential adverse events is currently debated. In particular, several safety data for JAK inhibitors are extrapolated from a single study in elderly patients with rheumatoid arthritis treated with tofacitinib or adalimumab/etanercept as a comparator. The population of patients with alopecia areata is clinically and immunologically different from persons with rheumatoid arthritis and tumor necrosis factor (TNF) inhibitors are not effective in these patients. The objective of this systematic review was to analyze available data on the safety of various JAK inhibitors in patients with alopecia areata. Methods The systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature review was performed by searching PubMed, Scopus and EBSCO databases with the last search on March 13, 2023. Results In total, 36 studies were included. The frequency and odds ratio (OR) for most common adverse events versus placebo were: for baricitinib hypercholesterolemia (18.2% vs 10.5%, OR = 1.9) and headache (6.1% vs 5.1%, OR = 1.2), for brepocitinib elevated creatinine level (27.7% vs 4.3%, OR = 8.6) and acne (10.6% vs 4.3%, OR = 2.7), for ritlecitinib acne (10.4% vs 4.3%, OR = 2.6) and headache (12.5% vs 10.6%, OR = 1.2) and for deuruxolitinib headache (21.4% vs 9.1%, OR = 2.7) and acne (13.6% vs 4.5%, OR = 3.3). The respective numbers for upper respiratory infections were: baricitinib (7.3% vs 7.0%, OR = 1.0) and brepocitinib (23.4% vs 10.6%, OR = 2.6); for nasopharyngitis: ritlecitinib (12.5% vs 12.8%, OR = 1.0) and deuruxolitinib (14.6% vs 2.3%, OR = 7.3). Conclusions The most common side effects of JAK inhibitors in patients with alopecia areata were headache and acne. The OR for upper respiratory tract infections varied from over 7-fold increased to comparable to placebo. The risk of serious adverse events was not increased. Supplementary Information The online version contains supplementary material available at 10.1007/s40261-023-01260-z.

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Section: Discussionmentioning

confidence: 99%

Safety of Janus Kinase inhibitors in Patients with Alopecia Areata: A Systematic Review

2023

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“…We have recently shown that patients with alopecia areata are at a risk of endothelial dysfunction, which is an early predictor of development of cardiovascular diseases [11]. Moreover, the study of Shin et al [12] assessed the risk of myocardial infarction was in 228,886 patients with alopecia areata and 4,577,720 matched controls during a 12-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…Nie odnotowano istotnej różnicy pomiędzy pacjentami z łysieniem plackowatym i grupą kontrolną pod względem częstości występowania cukrzycy i nadciśnienia tętniczego. W ostatnim czasie wykazaliśmy, że pacjenci z łysieniem plackowatym są narażeni na dysfunkcję śródbłonka, która stanowi wczesny predyktor chorób sercowo-naczyniowych [11]. W badaniu Shin i wsp.…”

Section: Discussionunclassified

Cardiovascular risk in patients with alopecia areata: a cross-sectional study

Waśkiel‐Burnat¹,

Dorobek²,

Kotowska³

et al. 2023

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Introduction:Numerous studies indicate that alopecia areata is associated with systemic inflammation with an increased serum level of proinflammatory cytokines. Recent studies have indicated a higher incidence of cardiovascular diseases in patients with alopecia areata. Objective: To evaluate the cardiovascular risk calculated with various scoring systems in patients with alopecia areata compared to the controls. Material and methods:In the present study, the cardiovascular risk was evaluated in 91 patients with alopecia areata and 47 controls with the use of QRESEARCH risk estimator version 3 (QRISK-3), Framingham Risk score -Coronary heart disease (FRS-CHD), Framingham Risk Score -Cardiovascular disease (FRS-CVD), Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator Plus and Systematic Coronary Risk Evaluation (SCORE) risk charts.Results: An increased median QRISK-3 was observed in patients with alopecia areata compared to controls (1.2 [0.5-5.5] vs. 0.9 [0.2-3.2]; p < 0.05). Moreover, higher median FRS-CHD, FRS-CVD, ASCVD Risk Estimator Plus scores were detected in patients with alopecia areata compared to control subjects (4.5 (2.4-9) vs. 3.35 (1.5-6.7); 0.85 (0.1-2.4) vs. 0.45 (0.1-1) and 2.5 (0.7-8.2) vs. 1.9 (0.8-4.3), respectively). However, those differences were not statistically significant (p > 0.05). In patients with alopecia areata, a positive correlation was observed between QRISK-3 and the age of the patient, body mass index, systolic blood pressure, diastolic blood pressure, total cholesterol, LDL-cholesterol and triglycerides. Conclusions: Alopecia areata is associated with an increased cardiovascular risk. Regular cardiovascular screening should be recommended to every patient with alopecia areata.

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“…9 Recent studies have shown that alopecia areata may be associated with an increased risk of developing hypertension, hyperlipidemia, obesity, metabolic syndrome and cardiovascular diseases. 10,11…”

Section: Introductionmentioning

confidence: 99%

“…Associations between alopecia areata and atopic diseases, such as atopic dermatitis, asthma, allergic rhinitis and allergic conjunctivitis are well‐documented 9 . Recent studies have shown that alopecia areata may be associated with an increased risk of developing hypertension, hyperlipidemia, obesity, metabolic syndrome and cardiovascular diseases 10,11 …”

Section: Introductionmentioning

confidence: 99%

European expert consensus statement on the systemic treatment of alopecia areata

Rudnicka,

Arenbergerova,

Grimalt

et al. 2024

Acad Dermatol Venereol

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Alopecia areata is an autoimmune form of non‐scarring hair loss. It is usually characterized by limited areas of hair loss. However, the disease may progress to complete scalp and body hair loss (alopecia totalis, alopecia universalis). In patients with alopecia areata hair loss significantly impacts the quality of life. Children and adolescents with alopecia areata often experience bullying, including physical aggression. The disease severity evaluation tools used in clinical practice are: the Severity of Alopecia Tool (SALT) score and the Alopecia Areata Scale (AAS). A SALT score equal to or greater than 20 constitutes a commonly accepted indication for systemic therapy in alopecia areata. When using the AAS, moderate to severe alopecia areata should be considered a medical indication for systemic treatment. Currently, the only two EMA‐approved medications for alopecia areata are baricitinib (JAK 1/2 inhibitor) for adults and ritlecitinib (JAK 3/TEC inhibitor) for individuals aged 12 and older. Both are EMA‐approved for patients with severe alopecia areata. Other systemic medications used off‐label in alopecia areata include glucocorticosteroids, cyclosporine, methotrexate and azathioprine. Oral minoxidil is considered an adjuvant therapy with limited data confirming its possible efficacy. This consensus statement is to outline a systemic treatment algorithm for alopecia areata, indications for systemic treatment, available therapeutic options, their efficacy and safety, as well as the duration of the therapy.

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Patients with alopecia areata are at risk of endothelial dysfunction: results of a case–control study

Cited by 7 publications

References 18 publications

Safety of Janus Kinase inhibitors in Patients with Alopecia Areata: A Systematic Review

Safety of Janus Kinase inhibitors in Patients with Alopecia Areata: A Systematic Review

Cardiovascular risk in patients with alopecia areata: a cross-sectional study

European expert consensus statement on the systemic treatment of alopecia areata

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