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An oral medication originally developed to treat arthritis has shown significant potential for people with severe alopecia areata, with some patients experiencing complete or near-complete scalp hair regrowth during two international clinical trials.
The drug, upadacitinib, was tested in patients who had lost most of their scalp hair due to the autoimmune condition. Researchers found that after 24 weeks of treatment, roughly half of the participants receiving either of two doses achieved at least 80% scalp hair coverage. Some patients experienced complete restoration.
Alopecia areata occurs when the immune system mistakenly attacks hair follicles, leading to hair loss that can range from small patches to the loss of most hair on the scalp and other parts of the body.
Upadacitinib belongs to a class of medications called Janus kinase, or JAK, inhibitors. These drugs suppress specific immune system signals involved in inflammation. Researchers believe this mechanism may also help prevent immune cells from attacking hair follicles.
The two trials involved medical centers across North America, Europe, and China. Participants entered the studies with an average loss of about 84% of their scalp hair, meaning many had relatively little hair remaining before treatment began.
Patients were randomly assigned to receive either 15 milligrams or 30 milligrams of upadacitinib, or a placebo, once daily. The results, published on August 12 in JAMA Dermatology, showed that both treatment groups experienced substantially greater hair regrowth than those receiving the placebo.
The findings are particularly significant for people with severe and persistent forms of alopecia areata. Some participants had experienced no meaningful hair regrowth for at least six months before joining the trials.
However, researchers cautioned that the results varied between patients, with the degree and speed of regrowth differing considerably. Longer-term studies will also be needed to determine whether the restored hair remains after extended treatment and to further assess potential risks.
Upadacitinib is already approved for several inflammatory conditions, including rheumatoid arthritis, giving researchers an existing body of evidence regarding its mechanism and safety profile. The latest results suggest that the drug could potentially offer another treatment option for patients with severe alopecia areata.
While complete hair restoration was not experienced by every participant, the results indicate that targeting the immune system may allow some patients with extensive hair loss to achieve dramatic regrowth within months.
