Today I’m writing with a bit of good news. A new treatment for hair loss seems to work miracles, at least for some patients. But for starters, let me be clear that this treatment doesn’t work for ordinary, age-related hair loss, where people (men especially) gradually lose the hair on their heads. It only treats alopecia areata, a far less common but much more damaging condition.
Alopecia areata is an autoimmune disease that causes dramatic and devastating hair loss. It’s nothing like normal age-related hair loss. In severe cases of alopecia areata, people can lose all their hair, often very rapidly, even their eyebrows and eyelashes. Sometimes they even lose the hairs in their nose and ears, which can lead to sinus infections and hearing problems. In milder cases, people develop bald spots on their scalp, and for some people the hair will grow back. In other cases, though, hair loss is permanent.
Alopecia affects about 300,000 Americans, and in addition to the physical symptoms, it often causes severe emotional distress. As a doctor explained to the New York Times this week, it “robs a person of their identity.”
The good news is that just a few days ago, the FDA approved the first-ever systemic treatment for alopecia areata, one that is genuinely effective, even if it doesn’t work for all patients. The new drug, called Olumiant, was developed by Eli Lilly and approved 4 years ago for treatment of rheumatoid arthritis. Its use for alopecia is an unexpected benefit.
The best way to illustrate the success this new drug is to look at a photo of one of the patients from the clinical trials, which were published on May 5 by an international group of doctors and scientists in the New England Journal Medicine. Below is one of the patients after 36 weeks of treatment:
Figure S8(e) from B. King et al., "Two Phase 3 Trials of Baricitinib for Alopecia Areata", N Engl J Med 2022;386:1687-99. DOI: 10.1056/NEJMoa2110343.
NEW ENGLAND JOURNAL OF MEDICINEThe NEJM article included photos of 6 patients, all of them just as dramatic as this one. Over the course of eight or nine months of treatment, many of the patients had virtually all their hair grow back.
How does the new drug work? In patients with alopecia areata, their immune system attacks their own hair follicles, for reasons that aren’t fully understood. It may be caused by both genetic and environmental factors. Olumiant (also called baricitinib) blocks the action of a protein called Janus kinase (JAK), which is one of the genes involved in the disease. This apparently allows the follicles to heal, and hair just starts growing again. As far back as 2014, a different JAK inhibitor was reported to induce dramatic hair re-growth in an alopecia areata patient, a young man who had lost all the hair on his body. That report and others like it were the motivation for conducting the just-reported clinical trials.
An important caveat is that not all patients responded equally well. Both studies had a low-dose and high-dose option, and the higher dose clearly worked better, with 36% of patients in one study and 39% in the other study experience dramatic re-growth of hair during an 8-month period. Most side effects were mild, but the studies will continue to monitor patients for longer-term side effects.
Even if it only works for some patients, this is clearly a dramatic breakthrough for alopecia areata. One downside is cost: as with many drugs in the U.S., Olumiant is really expensive. The NY Times reports that the cost is currently $2500 per month, which means an 8-month course of treatment will cost $20,000. Thanks to the FDA’s approval, insurance will probably cover it, but no drug should cost that much.