Arthritis Drug Helped 1 in 3 Alopecia Patients Regrow Hair

A medication commonly used for rheumatoid arthritis may also help treat alopecia areata, an autoimmune condition that leads to rapid hair loss.

That’s the main finding of a new study published in The New England Journal of Medicine that analyzed the impact of Olumiant (baricitinib), which is in a class of medications known as Janus kinase (JAK) inhibitors, on patients with alopecia areata.

The study featured the results of two clinical trials featuring a total of 1,200 patients with severe alopecia areata. The patients were randomly assigned to receive a once-daily dose of 4 milligrams (mg) of Olumiant, a 2mg dose of Olumiant, or a placebo and monitored for 36 weeks.

The researchers discovered that one in three patients with alopecia areata were able to regrow hair after being treated with Olumiant, with those in the 4mg group having the most success—up to 50% improvement in hair regrowth.

“Alopecia areata is an autoimmune disorder marked by disfiguring, non-scarring hair loss, and there are no therapies approved by the U.S. Food and Drug Administration [FDA] for treatment of the disease,” Brett King, MD, PhD, lead study author and an associate professor of dermatology at the Yale School of Medicine, told Verywell. “Up until recently, there have been only small studies suggesting that a class of medicines called Janus kinase inhibitors are effective for the treatment of alopecia areata.”

This was a phase 3 clinical trial, which is typically the last step needed before a medication can be submitted for FDA approval.

Existing Alopecia Treatment

Alopecia areata is an autoimmune condition that develops when the body attacks its own hair follicles. It can cause hair loss anywhere on the body but typically leads to noticeable hair loss on the scalp, eyebrows, and eyelashes.

Alopecia areata can cause unpredictable hair loss, and it can also impact the nails, causing them to become brittle and red. Most people develop the condition during childhood or in their teens, and about half of them will regrow hair within 12 months without treatment.

Treatment options for alopecia areata are limited at the moment.

“For mild cases of the condition, monthly corticosteroid injections help suppress the immune reaction,” Ife J. Rodney, MD, founding director of Eternal Dermatology + Aesthetics and professor of dermatology at Howard University and George Washington University, told Verywell.

However, she said, topical or oral steroids may also help in addition to the injections. “Daily oral steroids also help for severe, extensive alopecia,” Rodney said. “This can reduce the overall immune system and must happen under your doctor’s supervision. They also should not be used long-term.”

Medications used to treat male and female-pattern baldness can also treat alopecia areata and come in the form of topical creams or shampoos, Rodney said. Still, “using these medications alone may not prevent new bald patches from forming,” she pointed out.

If all else fails, medications like cyclosporine tablets or other immunosuppressants are considered a “last resort” treatment, Rodney said.

Existing treatment options for alopecia areata aren’t perfect, Joshua Zeichner, MD, director of cosmetic and clinical research at the Icahn School of Medicine at Mount Sinai in New York, told Verywell. “High dose oral steroids have been used with mild success,” he said. Unfortunately, even those results don’t last.

“The hair usually falls out again after the therapy is stopped,” Zeichner said.

How Olumiant Helps Regrow Hair

Olumiant helps disrupt the communication of immune cells that harm hair follicles when someone has alopecia areata, King explained. “When the messaging is interrupted, the immune cells leave hair follicles alone and the hair follicles do what they are supposed to—that is, grow hair,” he said.

The phase 3 clinical trial findings could lead to an FDA approval of Olumiant to treat alopecia areata. This approval could have a big impact on patients.

“Alopecia areata can be devastating for patients, so baricitinib offers new hope to patients who are suffering,” Zeichner said.

All medications come with a risk-benefit ratio, Zeichner said, and it’s important for patients to figure out if a treatment is right for them. Rodney agrees. “Some patients may be concerned about the side effects discovered in the study, like acne and increased cholesterol,” she said.

Still, the medication and findings “opens a door for patients who do not want to use steroids to treat alopecia areata out of fear of the side effects,” Rodney said. “It’s also an option for those who’ve tried steroids and failed.”

Overall, Rodney noted, “it’s something to keep an eye on.”

King anticipates that his data will help lead to an FDA approval in the future. “Hopefully we will learn of FDA approval of baricitinib for alopecia areata in the months ahead,” he said.