https://doi.org/10.4081/reumatismo.2024.1685

Sudden improvement of alopecia universalis and psoriatic arthritis while receiving upadacitinib: a case-based review

Early Access
Submitted: 22 November 2023
Accepted: 6 June 2024
Published: 25 October 2024
JAK inhibitor, alopecia universalis, psoriatic arthritis, alopecia areata, upadacitinib
Abstract Views: 799
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Authors

C. Perricone
carlo.perricone@unipg.it
https://orcid.org/0000-0003-4771-6981
Rheumatology, Department of Medicine and Surgery, University of Perugia, Italy.
R. Dal Pozzolo
https://orcid.org/0009-0004-2157-4908
Rheumatology, Department of Medicine and Surgery, University of Perugia, Italy.
G. Cafaro
Rheumatology, Department of Medicine and Surgery, University of Perugia, Italy.
S. Calvacchi
Rheumatology, Department of Medicine and Surgery, University of Perugia, Italy.
L. Bruno
Rheumatology, Department of Medicine and Surgery, University of Perugia, Italy.
F. Tromby
Rheumatology, Department of Medicine and Surgery, University of Perugia, Italy.
A. Colangelo
Rheumatology, Department of Medicine and Surgery, University of Perugia, Italy.
R. Gerli
Rheumatology, Department of Medicine and Surgery, University of Perugia, Italy.
E. Bartoloni
Rheumatology, Department of Medicine and Surgery, University of Perugia, Italy.

Alopecia universalis (AU), an advanced form of alopecia areata (AA), is a condition characterized by the complete loss of hair over the entire skin surface. Recent progress has significantly enhanced our understanding of the pathogenesis of AU. In particular, interferon-γ (IFN-γ) and interleukin (IL)-15 seem to play a pivotal role in the pathogenesis of the disease. Nonetheless, a variety of medications has been used to treat the disease with frequently inconsistent results. Given the broad modulation of the immune system and inhibition of key molecules, including IFN-γ and IL-15, oral janus kinase (JAK) inhibitors represent a treatment option for moderate to severe cases of AA, as demonstrated in case reports supporting their efficacy and tolerability. We present the case of a patient suffering from psoriatic arthritis and AU who experienced a sudden improvement in peripheral arthritis and AU while receiving JAK1 selective treatment with upadacitinib. So far, there are very limited case reports of successful upadacitinib treatment for patients with AA, mostly in patients also suffering from atopic dermatitis. Thus, we provide evidence for the efficacy of upadacitinib in managing AU in adults, also in the context of an inflammatory arthritis such as psoriatic arthritis.

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Liu LY, King BA, Craiglow BG. Alopecia areata is associated with impaired health-related quality of life: A survey of affected adults and children and their families. J Am Acad Dermatol 2018; 79: 556-8.e1 DOI: https://doi.org/10.1016/j.jaad.2018.01.048
Rencz F, Gulácsi L, Péntek M, Wikonkál N, Baji P, Brodszky V. Alopecia areata and health-related quality of life: a systematic review and meta-analysis. Br J Dermatol 2016; 175: 561-71. DOI: https://doi.org/10.1111/bjd.14497
Liu LY, King BA, Craiglow BG. Health-related quality of life (HRQoL) among patients with alopecia areata (AA): a systematic review. J Am Acad Dermatol 2016; 75: 806-12.e3. DOI: https://doi.org/10.1016/j.jaad.2016.04.035
Aghaei S, Saki N, Daneshmand E, Kardeh B. Prevalence of psychological disorders in patients with alopecia areata in comparison with normal subjects. ISRN Dermatol 2014; 2014: 304370. DOI: https://doi.org/10.1155/2014/304370
Islam N, Leung PS, Huntley AC, Gershwin ME. The autoimmune basis of alopecia areata: a comprehensive review. Autoimmun Rev 2015; 14: 81-9. DOI: https://doi.org/10.1016/j.autrev.2014.10.014
Darwin E, Hirt PA, Fertig R, Doliner B, Delcanto G, Jimenez JJ. Alopecia areata: review of epidemiology, clinical features, pathogenesis, and new treatment options. Int J Trichology 2018; 10: 51-60. DOI: https://doi.org/10.4103/ijt.ijt_99_17
Park H, Yu DA, Kwon O. Janus kinase inhibitors: an innovative treatment for alopecia areata. J Dermatol 2019; 46: 724-30. DOI: https://doi.org/10.1111/1346-8138.14986
Olamiju B, Friedmann A, King B. Treatment of severe alopecia areata with baricitinib. JAAD Case Rep 2019; 5: 892-4. DOI: https://doi.org/10.1016/j.jdcr.2019.07.005
Kwon O, Senna MM, Sinclair R, Ito T, Dutronc Y, Lin CY, et al. Efficacy and safety of baricitinib in patients with severe alopecia areata over 52 weeks of continuous therapy in two phase iii trials (BRAVE-AA1 and BRAVE-AA2). Am J Clin Dermatol 2023; 24: 443-51. DOI: https://doi.org/10.1007/s40257-023-00764-w
Ismail FF, Sinclair R. JAK inhibition in the treatment of alopecia areata - a promising new dawn? Expert Rev Clin Pharmacol 2020; 13: 43-51. DOI: https://doi.org/10.1080/17512433.2020.1702878
McElwee KJ, Freyschmidt-Paul P, Hoffmann R, Kissling S, Hummel S, Vitacolonna M, et al. Transfer of CD8(+) cells induces localized hair loss whereas CD4(+)/CD25(-) cells promote systemic alopecia areata and CD4(+)/CD25(+) cells blockade disease onset in the C3H/HeJ mouse model. J Invest Dermatol 2005; 124: 947-57. DOI: https://doi.org/10.1111/j.0022-202X.2005.23692.x
Paus R, Slominski A, Czarnetzki BM. Is alopecia areata an autoimmune-response against melanogenesis-related proteins, exposed by abnormal MHC class I expression in the anagen hair bulb? Yale J Biol Med 1993; 66: 541-54.
Rückert R, Hofmann U, van der Veen C, Bulfone-Paus S, Paus R. MHC class I expression in murine skin: developmentally controlled and strikingly restricted intraepithelial expression during hair follicle morphogenesis and cycling, and response to cytokine treatment in vivo. J Invest Dermatol 1998; 111: 25-30. DOI: https://doi.org/10.1046/j.1523-1747.1998.00228.x
Gilhar A, Kam Y, Assy B, Kalish RS. Alopecia areata induced in C3H/HeJ mice by interferon-gamma: evidence for loss of immune privilege. J Invest Dermatol 2005; 124: 288-9. DOI: https://doi.org/10.1111/j.0022-202X.2004.23580.x
Xing L, Dai Z, Jabbari A, Cerise JE, Higgins CA, Gong W, de Jong A, et al. Alopecia areata is driven by cytotoxic T lymphocytes and is reversed by JAK inhibition. Nat Med 2014; 20: 1043-9. DOI: https://doi.org/10.1038/nm.3645
King B, Ohyama M, Kwon O, Zlotogorski A, Ko J, Mesinkovska NA, et al. Two phase 3 trials of baricitinib for alopecia areata. N Engl J Med 2022; 386: 1687-99. DOI: https://doi.org/10.1056/NEJMoa2110343
Traves PG, Murray B, Campigotto F, Galien R, Meng A, Di Paolo JA. JAK selectivity and the implications for clinical inhibition of pharmacodynamic cytokine signalling by filgotinib, upadacitinib, tofacitinib and baricitinib. Ann Rheum Dis 2021; 80: 865-75. DOI: https://doi.org/10.1136/annrheumdis-2020-219012
McInnes IB, Byers NL, Higgs RE, Lee J, Macias WL, Na S, et al. Comparison of baricitinib, upadacitinib, and tofacitinib mediated regulation of cytokine signaling in human leukocyte subpopulations. Arthritis Res Ther 2019; 21: 183. DOI: https://doi.org/10.1186/s13075-019-1964-1
Papp KA, Menter MA, Raman M, Disch D, Schlichting DE, Gaich C, et al. A randomized phase 2b trial of baricitinib, an oral Janus kinase (JAK) 1/JAK2 inhibitor, in patients with moderate-to-severe psoriasis. Br J Dermatol 2016; 174: 1266-76. DOI: https://doi.org/10.1111/bjd.14403
Zhang L, Guo L, Wang L, Jiang X. The efficacy and safety of tofacitinib, peficitinib, solcitinib, baricitinib, abrocitinib and deucravacitinib in plaque psoriasis - a network meta-analysis. J Eur Acad Dermatol Venereol 2022; 36: 1937-46. DOI: https://doi.org/10.1111/jdv.18263
Johnston LA, Lu C, Poelman SM. Successful treatment of concomitant alopecia universalis and Crohn's disease with upadacitinib: a case report. SAGE Open Med Case Rep 2023; 11: 2050313X231160914. DOI: https://doi.org/10.1177/2050313X231160914
Gori N, Cappilli S, Di Stefani A, Tassone F, Chiricozzi A, Peris K. Assessment of alopecia areata universalis successfully treated with upadacitinib. Int J Dermatol 2023; 62: e61-3. DOI: https://doi.org/10.1111/ijd.16342
Youssef S, Bordone LA. Effective treatment of alopecia universalis with oral upadacitinib. JAAD Case Rep 2023; 31: 80-2. DOI: https://doi.org/10.1016/j.jdcr.2022.08.014
Asfour L, Getsos Colla T, Moussa A, Sinclair RD. Concurrent chronic alopecia areata and severe atopic dermatitis successfully treated with upadacitinib. Int J Dermatol 2022; 61: e416-7. DOI: https://doi.org/10.1111/ijd.16316
Cantelli M, Martora F, Patruno C, Nappa P, Fabbrocini G, Napolitano M. Upadacitinib improved alopecia areata in a patient with atopic dermatitis: a case report. Dermatol Ther 2022; 35: e15346. DOI: https://doi.org/10.1111/dth.15346
Gambardella A, Licata G, Calabrese G, De Rosa A, Alfano R, Argenziano G. Dual efficacy of upadacitinib in 2 patients with concomitant severe atopic dermatitis and alopecia areata. Dermatitis 2021; 32: e85-6. DOI: https://doi.org/10.1097/DER.0000000000000780
Novielli D, Foti C, Principi M, Mortato E, Romita P, Dell'Aquila P, et al. Upadacitinib in concurrent Crohn's disease, atopic dermatitis and alopecia areata: a case report. J Eur Acad Dermatol Venereol 2023; 38: e8-10. DOI: https://doi.org/10.1111/jdv.19377
Walls B, Reguiai Z. Dual efficacy of upadacitinib in a patient with concomitant severe atopic dermatitis and alopecia areata. Ann Dermatol Venereol 2023; 150: 281-3. DOI: https://doi.org/10.1016/j.annder.2023.03.010
Johnston LA, Poelman SM. Upadacitinib for management of recalcitrant alopecia areata: a retrospective case series. JAAD Case Rep 2023; 35: 38-42. DOI: https://doi.org/10.1016/j.jdcr.2023.02.019
Flora A, Kozera E, Frew JW. Treatment of alopecia areata with the janus kinase inhibitor upadacitinib: a retrospective cohort study. J Am Acad Dermatol 2023; 89: 137-8. DOI: https://doi.org/10.1016/j.jaad.2022.12.056
Chiricozzi A, Balato A, Fabbrocini G, Di Nardo L, Babino G, Rossi M, et al. Beneficial effects of upadacitinib on alopecia areata associated with atopic dermatitis: a multicenter retrospective study. J Am Acad Dermatol 2023; 89: 1251-3. DOI: https://doi.org/10.1016/j.jaad.2023.05.001

How to Cite

Perricone, C., Dal Pozzolo, R., Cafaro, G., Calvacchi, S., Bruno, L., Tromby, F., … Bartoloni, E. (2024). Sudden improvement of alopecia universalis and psoriatic arthritis while receiving upadacitinib: a case-based review. Reumatismo. https://doi.org/10.4081/reumatismo.2024.1685
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