All information has been taken from the ABC Interview located in this link.

https://www.abc.net.au/radionational/programs/healthreport/alopecia-treatments-false-promises/102142714

Statement from Professor Rodney Sinclair a Professor of Dermatology at the University of Melbourne and director of Epworth Dermatology.

We went pretty much 40 years without a single new treatment, and then in the past two or three years, we’ve probably got about 40 new emerging treatments. And this often happens in medicine, that once people make the fundamental breakthrough in science, molecular biology, then targeted treatments develop. And then once someone proves a targeted treatment works, then all the other pharmaceutical companies try and copy it, and develop modifications to it. And so the field moves very, very quickly.

We saw this at the turn of the century with psoriasis. We got the very first biologic treatments for psoriasis, and within a few years, we had about 20 new treatments. And as a consequence of that, all the psoriasis wards in the hospitals had to close because the patients were now being managed as outpatients with injectable treatments. I suspect we have seen similar changes in other diseases, with rheumatoid arthritis and perhaps even inflammatory bowel disease. I think we’re on the cusp of seeing the emergence of a new paradigm shift in the treatment of alopecia on our doorstep.

How effective are the treatments?

The historical treatment for alopecia was prednisone. Prednisolone worked in about 80% of patients, but many people had to continue taking it and then they started to accumulate all the side effects associated with prolonged prednisone use. It’s a steroid and so that steroid treatment gave the treatment a bad name because many people were either intolerant of the side effects or made a decision that the side effects were worse than the disease itself. That’s now changed with these new treatments. They belong to a family of medications called Janus Kinase Inhibitors (JAK).
JAKs were actually invented at the Walter and Eliza Hall here in Melbourne. A fellow called Andrew Wilks who basically set the whole ball in motion, spoke at one of the conferences we ran in Melbourne, he was saying that globally there are over $20 billion in annual sales of these Janus kinase inhibitors for the treatment of a whole range of diseases, of which alopecia areata is probably the newest one added to the list.
And what we’ve just seen in the last few months is the first of these medications has now got FDA approval in the United States, and so that’s now being widely prescribed throughout America. It’s got approval in Europe through what’s called the EMA, which is their equivalent, the equivalent in Japan. And it’s now under consideration by the TGA. And so, when you think about all these regulatory bodies around the world, the FDA is probably the highest bar that you’ve got to get over, and this medication is now an FDA-approved treatment for alopecia.

Does the hair stop growing when people stop taking JAKs

We’ve been fortunate enough to have patients enrolled in clinical trials using these medications for the past six years now at our centre and had a number of patients who have been able to stop the treatments, and they’ve managed to continue to keep their hair. But there are also patients who when you stop the treatment, it relapses. And a little bit of that depends on how long they’ve had the disease before they have the treatment. Patients who might have had the disease for 10 or 15 years, they’re more likely to require ongoing treatment. However, patients who are newly diagnosed tend to have a better prognosis, and many of them can stop the treatments without a problem. But ongoing treatment is not necessarily a problem because in diseases like rheumatoid arthritis, for which some of these drugs were originally designed, it was always the intention that people would take it lifelong, and so the safety profile for these medications, when they were being developed, was designed for people to take it lifelong. In alopecia areata, I think we’re going to be fortunate that many patients will be able to stop the treatment after a period of time.

If you’re having this treatment for life, are there side effects that accumulate?

There don’t appear to be side effects that accumulate. It tends to be very well tolerated. With the one medication that’s been approved by the FDA in the United States, that’s one called Baricitinib, the main side effect that we tend to see is a little bit of mild acne that we can manage with some topical antibiotic ointment. We sometimes see a mild elevation in their cholesterol but it’s not enough to require treatment and, on the whole, it’s a really well-tolerated treatment.