The Alopecia Areata Consensus of Experts (ACE) study: Results of an international expert opinion on treatments for alopecia areata

Meah, Nekma; Wall, Dmitri; York, Katherine; Bhoyrul, Bevin; Bokhari, Laita; Sigall, Daniel Asz; Bergfeld, Wilma F.; Betz, Regina C.; Blume-Peytavi, Ulrike; Callender, Valerie D.; Chitreddy, Vijaya; Combalía, Andrea; Cotsarelis, George; Craiglow, Brittany G.; Donovan, Jeff; Eisman, Samantha; Farrant, Paul; Green, Jack; Grimalt, Ramón; Harries, Matthew; Hordinsky, Maria; Irvine, Alan D.; Itami, Satoshi; Jolliffe, Victoria; King, Brett; Lee, Won Soo; McMichael, Amy J.; Messenger, A.G.; Mirmirani, Paradi; Olsen, Elise A.; Orlow, Seth J.; Piraccini, Bianca Maria; Rakowska, Adriana; Reygagne, P.; Roberts, Janet L.; Rudnicka, Lidia; Shapiro, Jerry; Sharma, Pooja; Tosti, Antonella; Vogt, Annika; Wade, Martin; Yip, Leona; Zlotogorski, Abraham; Sinclair, Rodney

doi:10.1016/j.jaad.2020.03.004

Cited by 140 publications

(206 citation statements)

References 14 publications

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“…There is no consensus regarding the standard treatment guideline for AA; however, various strategies have been proposed by several expert groups based on the current evidence [3][4][5][6][7][8]. Treatment decisions in each algorithm depend on patient age, disease activity, disease severity, and treatment responses.…”

Section: Rationale For the Treatment Of Aamentioning

confidence: 99%

“…Other regimens reported for treating severe AA include pulse oral prednisolone 200 mg once weekly or oral betamethasone 5 mg for two consecutive days weekly for 12 weeks, intramuscular triamcinolone acetonide (imTA) 40 mg once monthly for six months, and intravenous methylprednisolone (ivMP) 500 mg for three consecutive days at four-week intervals for three months [4][5][6][7][8]. The response rate of systemic corticosteroids is about 80%; however, approximately 50% of patients experience recurrence after discontinuation of treatment [4][5][6][7][8]. Due to the longer half-life of imTA and ivMP compared to OCs, both treatments provide a higher risk of potential adverse effects, especially hypothalamic-pituitary-adrenal axis suppression.…”

Section: Systemic Treatments For Aamentioning

confidence: 99%

“…Corticosteroid-sparing agents are recommended in patients with AA who require long-term systemic treatment. Methotrexate revealed complete hair regrowth in 63% of patients [4][5][6][7][8]. The dose was started at 5-10 mg once weekly and slightly increased every four to six weeks up to 15-25 mg/week [14].…”

Section: Systemic Treatments For Aamentioning

confidence: 99%

“…The dose was started at 5-10 mg once weekly and slightly increased every four to six weeks up to 15-25 mg/week [14]. Cyclosporine is prescribed at 3-5 mg/ kg/day, demonstrating a response rate of 55-76%; however, treatment duration should be limited to 6-12 months due to its side effects of renal dysfunction and increased blood pressure [4][5][6][7][8]15]. JAK inhibitors are a novel treatment and reveal promising results for recalcitrant AA.…”

Section: Systemic Treatments For Aamentioning

confidence: 99%

“…Prevention of relapse by maintenance therapy is also currently not recommended since the interval between occurrences is unpredictable. According to several major treatment guidelines for AA, patients with hair regrowth less than expected after six months of therapy are considered a treatment failure necessitating consideration of other therapeutic methods [3][4][5][6][7][8]. Prognostic factors may predict inadequate treatment response and help physicians select appropriate modalities that can be used as long-term therapy safely, such as topical contact immunotherapy.…”

Section: Expert Opinionmentioning

confidence: 99%

See 4 more Smart Citations

Are drug treatment strategies really effective against alopecia areata?

Rattananukrom

Suchonwanit

2020

Expert Opinion on Pharmacotherapy

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Section: Rationale For the Treatment Of Aamentioning

confidence: 99%

Section: Systemic Treatments For Aamentioning

confidence: 99%

Section: Systemic Treatments For Aamentioning

confidence: 99%

Section: Systemic Treatments For Aamentioning

confidence: 99%

Section: Expert Opinionmentioning

confidence: 99%

See 3 more Smart Citations

Are drug treatment strategies really effective against alopecia areata?

Rattananukrom

Suchonwanit

2020

Expert Opinion on Pharmacotherapy

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A Global eDelphi Exercise to Identify Core Domains and Domain Items for the Development of a Global Registry of Alopecia Areata Disease Severity and Treatment Safety (GRASS)

et al. 2021

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IMPORTANCEA recent expert consensus exercise emphasized the importance of developing a global network of patient registries for alopecia areata to redress the paucity of comparable, real-world data regarding the effectiveness and safety of existing and emerging therapies for alopecia areata.OBJECTIVE To generate core domains and domain items for a global network of alopecia areata patient registries.EVIDENCE REVIEW Sixty-six participants, representing physicians, patient organizations, scientists, the pharmaceutical industry, and pharmacoeconomic experts, participated in a 3-round eDelphi process, culminating in a face-to-face meeting at the World Congress of Dermatology,

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Treatment Patterns for Alopecia Areata in the US

Lee,

Huang,

Mostaghimi

et al. 2023

JAMA Dermatol

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ImportanceAlopecia areata (AA) is characterized by hair loss ranging from patches of hair loss to more extensive forms, including alopecia totalis (AT) and alopecia universalis (AU). There is a lack of consensus for treatment. Understanding current practice patterns could help the identification of treatment needs and development of standards of care.ObjectiveTo review treatment patterns for adults with AA in the US between 2015 and 2020.Design, Setting, and ParticipantsThis retrospective cohort study used medicine and pharmacy claims for commercially insured individuals from the IBM MarketScan Research Database to assess adults (≥18 years) newly treated for AA between October 15, 2015, and February 28, 2020. Alopecia areata was identified based on having at least 1 diagnosis of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code L63.x. Patients were required to have at least 365 days of continuous health plan enrollment before and after the cohort entry date. Patients were required to be free of AA diagnosis codes 365 days before the cohort entry date. Statistical analyses were conducted between 2019 and 2023.Main Outcomes and MeasuresMain outcomes were treatment patterns for all patients with AA and subgroups of (1) patients with AT or AU and (2) those cared for by a dermatologist on the cohort entry date. Longitudinal therapy course during the first year after the diagnosis was also examined.ResultsThe study cohort consisted of 45 483 individuals (mean [SD] age, 43.8 [14.2] years; 29 903 [65.7%] female). During the year of follow-up, 30 217 patients (66.4%) received at least 1 AA treatment. The most common treatments were intralesional (19 014 [41.8%]), topical (18 604 [40.9%]), intramuscular (17 328 [38.1%]), and oral (9378 [20.6%]) corticosteroids. Compared with patients without AT or AU, patients with AT or AU a lower frequency of intralesional steroid (359 [11.1%] vs 18 655 [44.1%], P &lt; .001) and higher frequency of topical corticosteroid (817 [25.4%] vs 17 787 [42.1%], P &lt; .001) use. Almost half of patients (21 489 [47.2%]) received no treatment on the day of diagnosis. By 12 months, 32 659 (71.8%) were not receiving any treatment, making no treatment the largest study group.Conclusions and RelevanceIn this large cohort study of commercially insured individuals, corticosteroids were the most commonly used treatment for adults with AA between 2015 and 2020. At 365 days after diagnosis, more than two-thirds of patients were no longer receiving any AA treatment. Further studies are needed to understand the reasons for the absence of treatment.

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The Alopecia Areata Consensus of Experts (ACE) study: Results of an international expert opinion on treatments for alopecia areata

Cited by 140 publications

References 14 publications

Are drug treatment strategies really effective against alopecia areata?

Are drug treatment strategies really effective against alopecia areata?

A Global eDelphi Exercise to Identify Core Domains and Domain Items for the Development of a Global Registry of Alopecia Areata Disease Severity and Treatment Safety (GRASS)

Treatment Patterns for Alopecia Areata in the US

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