Award Title: Baricitinib for treating severe alopecia areata [ID3979]
Funder: Department of Health and Social Care

Abstract: Alopecia areata is a chronic, inflammatory, autoimmune condition affecting the hair follicles leading to a sudden onset of hair loss. It does not cause scarring or permanent damage to the hair follicles. It can affect any hair-bearing skin such as the beard, eyebrows, eyelashes, body and limbs. The most common presentation of alopecia areata is small, round or oval patches of baldness on the scalp. Rarely, it may affect the whole scalp (alopecia totalis) or even the entire body and scalp (alopecia universalis). For some people, patchy hair loss may continue over a long period of time, referred to as persistent patchy or chronic alopecia areata. Other types of alopecia areata are characterised by different patterns of hair loss. For example, diffuse alopecia areata is characterised by sudden thinning of the hair all over the scalp, rather than in patches. Alopecia areata ophiasis refers to hair loss from the sides and lower back of the scalp, alopecia areata sisaipho refers to hair loss from the front of the scalp, forehead and rarely the eyebrows while alopecia barbae refers to hair loss in the beard and moustache area. [1],[2] _x000D_
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Alopecia areata occurs when hair follicles change from the growth (anagen) phase to the loss (telogen) phase prematurely, but the exact cause is unknown. While there is a genetic predisposition, it can occur at any age, affecting both males and females equally. [2] It is suggested that there may be higher incidence in children and young adults[3] and there may also be a link to social deprivation.[4] In the UK, it is estimated that approximately 0.6% of adults have alopecia areata, [4] of which 7% to 10% may have the severe form[5] and 10 to 50% may have nail involvement. [6] Alopecia areata is also associated with higher rates of atopic and other autoimmune conditions.[4]_x000D_
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Alopecia areata is typically diagnosed clinically based on presenting features such as patterns of hair loss, exclamation mark hairs (short, broken hairs tapering proximally) and a positive pull test.[3] Prognosis is unpredictable and varies depending on severity and duration of the condition. Spontaneous remission within one year is seen in up to 80% of people with limited patches of hair loss of less than one year duration.[1] When hair loss becomes extensive, spontaneous re-growth is rare._x000D_
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Clinical management depends on the severity of hair loss. If there is evidence of hair regrowth or there is less than 50% hair loss, management may include advice on cosmetic options to camouflage hair loss and watchful waiting. If there is no hair regrowth and more than 50% hair loss, treatment options in primary care may include topical corticosteroids, the only treatment currently licensed for use in alopecia areata. If hair loss does not respond to treatment, people may be referred to a dermatologist. Specialist management depends on disease duration, activity, location, extent, and the person's age and individual preference. It may include local corticosteroid injections or oral corticosteroids, dithranol, contact sensitisation treatment (contact immunotherapy), psoralen plus ultraviolet A light therapy (PUVA), minoxidil, immunosuppressive drugs such as oral azathioprine, ciclosporin, methotrexate and sulfasalazine and prostaglandin analogues such as bimatoprost and latanoprost. [1],[2],[6]_x000D_
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References_x000D_
1. NICE (2018) Clinical Knowledge Summaries Alopecia Areata. Accessed May 2022._x000D_
2. British Association of Dermatologists (2016) Patient Information Leaflet Alopecia Areata. Accessed May 2022._x000D_
3. BMJ Best Practice (2021) Alopecia areata. Accessed May 2022._x000D_
4. Harries M, Macbeth AE, Holmes S, Chiu WS, Gallardo WR, Nijher M, de Lusignan S, Tziotzios C, Messenger AG (2022) The epidemiology of alopecia areata: a population-based cohort study in UK primary care. Br J Dermatol 186(2):257-265._x000D_
5. Madani S, Shapiro J (2000) Alopecia areata update. J Am Acad Dermatol 42(4):549-66._x000D_
6. Alopecia UK “What is Alopecia Areata?” Accessed May 2022._x000D_
7. Alopecia UK “Treatments for Alopecia Areata” Accessed May 2022.

Lay Abstract: To appraise the clinical and cost effectiveness of baricitinib within its marketing authorisation for treating severe alopecia areata in adults.

Research Activity Codes: 6.1 PHARMACEUTICALS
Health Categories: INFLAMMATORY AND IMMUNE SYSTEM