Upadacitinib Shows Strong Hair Regrowth in Severe Alopecia Areata Trials

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A large pair of Phase 3 clinical trials suggests that upadacitinib, a drug already used for several inflammatory conditions, could also help people with severe alopecia areata, an autoimmune disease in which the immune system attacks hair follicles. The two trials included 1,399 adults and adolescents with substantial scalp hair loss and compared daily doses of upadacitinib with placebo over 24 weeks. In both trials, roughly 45 percent of people taking 15 milligrams and roughly 54 to 55 percent taking 30 milligrams reached a level representing at least 80 percent scalp hair coverage, compared with only a small fraction of people receiving placebo. Complete scalp hair regrowth occurred in about 13 to 22.5 percent of participants taking upadacitinib. The results are notable because severe alopecia areata can be difficult to treat and can have a major emotional and quality of life impact. The drug is a JAK inhibitor that reduces immune signaling involved in inflammation, providing a possible way to interrupt the immune attack on hair follicles. The study also reported improvements involving eyebrows, eyelashes, and quality of life. The findings do not mean that upadacitinib cures every kind of hair loss. Alopecia areata is different from common pattern hair loss, and the trials lasted only 24 weeks. Longer-term effectiveness and safety still need to be studied, and the trials were funded and co-designed by the drug manufacturer, with some researchers employed by the company. Further comparisons with existing treatments will help clarify where the drug fits in care.