Real-World Treatment Patterns among Patients with Alopecia Areata in the USA: A Retrospective Claims Analysis

Authors

DOI:

https://doi.org/10.2340/actadv.v103.12445

Keywords:

alopecia areata, alopecia totalis, alopecia universalis, treatment, adult, adolescent

Abstract

Alopecia areata is an autoimmune disorder characterized by hair loss, for which there are few treatment options. This claims-based study characterized recent real-world treatment patterns among patients in the USA with alopecia areata, including the subtypes alopecia totalis and alopecia universalis, in the first year after diagnosis of an episode of alopecia areata. Approximately 5% of all patients (adults (age ≥ 18 years), n = 7,703; adolescents (age 12–17 years), n = 595) had alopecia totalis or alopecia universalis. Corticosteroids were the most common first-line (1L) and second-line (2L) treatments. The mean time from diagnosis of alopecia areata to initiation of 1L treatment was 2.2 days for adults and 2.6 days for adolescents; mean 1L duration was 76.9 and 64.3 days, respectively. For adults (57.5%) and adolescents (59.7%) with 2L therapy, the mean time from 1L discontinuation to 2L initiation was 57.2 and 53.6 days, respectively; the mean duration of 2L treatment was 55.5 and 50.1 days, respectively. More patients with vs without alopecia totalis or alopecia universalis initiated 2L therapy (adults: 71.9% vs 56.8%; adolescents: 71.4% vs 58.9%). The proportion of days covered during the first year post-diagnosis was 36.7% (adults) and 34.1% (adolescents). These results highlight the substantial disease burden of alopecia areata and a need for more effective treatments.

Downloads

Download data is not yet available.

References

Pratt CH, King LE, Messenger AG, Christiano AM, Sundberg JP. Alopecia areata. Nature Rev Dis Primers 2017; 3: 17011.

https://doi.org/10.1038/nrdp.2017.11 DOI: https://doi.org/10.1038/nrdp.2017.11

Finner AM. Alopecia areata: cClinical presentation, diagnosis, and unusual cases. Dermatol Ther 2011; 24: 348-354.

https://doi.org/10.1111/j.1529-8019.2011.01413.x DOI: https://doi.org/10.1111/j.1529-8019.2011.01413.x

Benigno M, Anastassopoulos KP, Mostaghimi A, Udall M, Daniel SR, Cappelleri JC, et al. A large cross-sectional survey study of the prevalence of alopecia areata in the United States. Clin Cosmet Investig Dermatol 2020; 13: 259-266.

https://doi.org/10.2147/CCID.S245649 DOI: https://doi.org/10.2147/CCID.S245649

Mirzoyev SA, Schrum AG, Davis MDP, Torgerson RR. Lifetime incidence risk of alopecia areata estimated at 2.1% by Rochester Epidemiology Project, 1990-2009. J Invest Dermatol 2014; 134: 1141-1142.

https://doi.org/10.1038/jid.2013.464 DOI: https://doi.org/10.1038/jid.2013.464

Chu SY, Chen YJ, Tseng WC, Lin MW, Chen TJ, Hwang CY, et al. Comorbidity profiles among patients with alopecia areata: the importance of onset age, a nationwide population-based study. J Am Acad Dermatol 2011; 65: 949-956.

https://doi.org/10.1016/j.jaad.2010.08.032 DOI: https://doi.org/10.1016/j.jaad.2010.08.032

Price VH. Alopecia areata: Clinical aspects. J Invest Dermatol 1991; 96: 68S.

https://doi.org/10.1111/1523-1747.ep12471869 DOI: https://doi.org/10.1111/1523-1747.ep12471869

MacDonald Hull SP, Wood ML, Hutchinson PE, Sladden M, Messenger AG, British Association of D. Guidelines for the management of alopecia areata. Br J Dermatol 2003; 149: 692-699.

https://doi.org/10.1046/j.1365-2133.2003.05535.x DOI: https://doi.org/10.1046/j.1365-2133.2003.05535.x

Shapiro J, Madani S. Alopecia areata: diagnosis and management. Int J Dermatol 1999; 38: 19-24.

https://doi.org/10.1046/j.1365-4362.1999.00004.x DOI: https://doi.org/10.1046/j.1365-4362.1999.00004.x

Lyakhovitsky A, Aronovich A, Gilboa S, Baum S, Barzilai A. Alopecia areata: a long-term follow-up study of 104 patients. J Eur Acad Dermatol Venereol 2019; 33: 1602-1609.

https://doi.org/10.1111/jdv.15582 DOI: https://doi.org/10.1111/jdv.15582

Safavi KH, Muller SA, Suman VJ, Moshell AN, Melton LJ, 3rd. Incidence of alopecia areata in Olmsted County, Minnesota, 1975 through 1989. Mayo Clin Proc 1995; 70: 628-633.

https://doi.org/10.4065/70.7.628 DOI: https://doi.org/10.4065/70.7.628

Gip L, Lodin A, Molin L. Alopecia areata. A follow-up investigation of outpatient material. Acta Derm Venereol 1969; 49: 180-188.

Tosti A, Bellavista S, Iorizzo M. Alopecia areata: a long term follow-up study of 191 patients. J Am Acad Dermatol 2006; 55: 438-441.

https://doi.org/10.1016/j.jaad.2006.05.008 DOI: https://doi.org/10.1016/j.jaad.2006.05.008

Barahmani N, Schabath MB, Duvic M. History of atopy or autoimmunity increases risk of alopecia areata. J Am Acad Dermatol 2009; 61: 581-591.

https://doi.org/10.1016/j.jaad.2009.04.031 DOI: https://doi.org/10.1016/j.jaad.2009.04.031

Wang SJ, Shohat T, Vadheim C, Shellow W, Edwards J, Rotter JI. Increased risk for type I (insulin-dependent) diabetes in relatives of patients with alopecia areata (AA). Am J Med Genetics 1994; 51: 234-239.

https://doi.org/10.1002/ajmg.1320510313 DOI: https://doi.org/10.1002/ajmg.1320510313

Chu SY, Chen YJ, Tseng WC, Lin MW, Chen TJ, Hwang CY, et al. Psychiatric comorbidities in patients with alopecia areata in Taiwan: a case-control study. Br J Dermatol 2012; 166: 525-531.

https://doi.org/10.1111/j.1365-2133.2011.10714.x DOI: https://doi.org/10.1111/j.1365-2133.2011.10714.x

Ruiz-Doblado S, Carrizosa A, García-Hernández MJ. Alopecia areata: psychiatric comorbidity and adjustment to illness. Int J Dermatol 2003; 42: 434-437.

https://doi.org/10.1046/j.1365-4362.2003.01340.x DOI: https://doi.org/10.1046/j.1365-4362.2003.01340.x

Ghanizadeh A. Comorbidity of psychiatric disorders in children and adolescents with alopecia areata in a child and adolescent psychiatry clinical sample. Int J Dermatol 2008; 47: 1118-1120.

https://doi.org/10.1111/j.1365-4632.2008.03743.x DOI: https://doi.org/10.1111/j.1365-4632.2008.03743.x

Huang KP, Mullangi S, Guo Y, Qureshi AA. Autoimmune, atopic, and mental health comorbid conditions associated with alopecia areata in the United States. JAMA Dermatol 2013; 149: 789-794.

https://doi.org/10.1001/jamadermatol.2013.3049 DOI: https://doi.org/10.1001/jamadermatol.2013.3049

Egeberg A, Anderson S, Edson-Heredia E, Burge R. Comorbidities of alopecia areata: a population-based cohort study. Clin Exp Dermatol 2021; 46: 651-656.

https://doi.org/10.1111/ced.14507 DOI: https://doi.org/10.1111/ced.14507

Colón EA, Popkin MK, Callies AL, Dessert NJ, Hordinsky MK. Lifetime prevalence of psychiatric disorders in patients with alopecia areata. Compr Psychiatry 1991; 32: 245-251.

https://doi.org/10.1016/0010-440X(91)90045-E DOI: https://doi.org/10.1016/0010-440X(91)90045-E

Mostaghimi A, Napatalung L, Sikirica V, Winnette R, Xenakis J, Zwillich SH, et al. Patient perspectives of the social, emotional and functional impact of alopecia areata: a systematic literature review. Dermatol Ther 2021; 11: 867-883.

https://doi.org/10.1007/s13555-021-00512-0 DOI: https://doi.org/10.1007/s13555-021-00512-0

Villasante Fricke AC, Miteva M. Epidemiology and burden of alopecia areata: a systematic review. Clin Cosmet Investig Dermatol 2015; 8: 397-403.

https://doi.org/10.2147/CCID.S53985 DOI: https://doi.org/10.2147/CCID.S53985

Shi Q, Duvic M, Osei JS, Hordinsky MK, Norris DA, Price VH, et al. Health-related quality of life (HRQoL) in alopecia areata patients: a secondary analysis of the National Alopecia Areata Registry Data. J Investig Dermatol Symp Proc 2013; 16: S49-S50.

https://doi.org/10.1038/jidsymp.2013.18 DOI: https://doi.org/10.1038/jidsymp.2013.18

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: 556-558.e1.

https://doi.org/10.1016/j.jaad.2018.01.048 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: 561-571.

https://doi.org/10.1111/bjd.14497 DOI: https://doi.org/10.1111/bjd.14497

Senna M, Ko J, Tosti A, Edson-Heredia E, Fenske DC, Ellinwood AK, et al. Alopecia areata treatment patterns, healthcare resource utilization, and comorbidities in the US population using insurance claims. Adv Ther 2021; 38: 4646-4658.

https://doi.org/10.1007/s12325-021-01845-0 DOI: https://doi.org/10.1007/s12325-021-01845-0

Li SJ, Mostaghimi A, Tkachenko E, Huang KP. Association of out-of-pocket health care costs and financial burden for patients with alopecia areata. JAMA Dermatol 2019; 155: 493-494.

https://doi.org/10.1001/jamadermatol.2018.5218 DOI: https://doi.org/10.1001/jamadermatol.2018.5218

Xenakis J, Meche A, Smith T, Gruben D, Sikirica V. PSY29 Economic burden of alopecia areata in a US managed care population. Value Health 2019; 22: S379.

https://doi.org/10.1016/j.jval.2019.04.1853 DOI: https://doi.org/10.1016/j.jval.2019.04.1853

Mostaghimi A, Gandhi K, Done N, Ray M, Gao W, Carley C, et al. All-cause health care resource utilization and costs among adults with alopecia areata: a retrospective claims database study in the United States. J Mang Care Spec Pharm 2022; 28: 426-434.

https://doi.org/10.18553/jmcp.2022.28.4.426 DOI: https://doi.org/10.18553/jmcp.2022.28.4.426

Mostaghimi A, Xenakis J, Meche A, Smith TW, Gruben D, Sikirica V. Economic burden and healthcare resource use of alopecia areata in an insured population the United States. Derm Ther 2022; 12: 1027-1040.

https://doi.org/10.1007/s13555-022-00710-4 DOI: https://doi.org/10.1007/s13555-022-00710-4

OLUMIANT (baricitinib) Prescribing Information. June 2022. Indiaanpolis, IN: Eli Lilly and Co. [accessed 2023 May 4] Available from https://uspl.lilly.com/olumiant/olumiant.html#pi.

US Food and Drug Administration. FDA approves first systemic treatment for alopecia areata. 2022. [accessed 2023 May 4] Available from: https://www.fda.gov/news-events/press-announcements/fda-approves-first-systemic-treatment-alopecia-areata.

Wasserman D, Guzman-Sanchez DA, Scott K, McMichael A. Alopecia areata. Int J Dermatol 2007; 46: 121-131.

https://doi.org/10.1111/j.1365-4632.2007.03193.x DOI: https://doi.org/10.1111/j.1365-4632.2007.03193.x

Delamere FM, Sladden MM, Dobbins HM, Leonardi-Bee J. Interventions for alopecia areata. Cochrane Database Syst Rev 2008: CD004413.

https://doi.org/10.1002/14651858.CD004413.pub2 DOI: https://doi.org/10.1002/14651858.CD004413.pub2

Lai VWY, Chen G, Gin D, Sinclair R. Systemic treatments for alopecia areata: a systematic review. Australas J Dermatol 2019; 60: e1-e13.

https://doi.org/10.1111/ajd.12913 DOI: https://doi.org/10.1111/ajd.12913

Rattananukrom T, Suchonwanit P. Are drug treatment strategies really effective against alopecia areata? Ex Opin Pharmacother 2021; 22: 257-260.

https://doi.org/10.1080/14656566.2020.1854728 DOI: https://doi.org/10.1080/14656566.2020.1854728

Ramos PM, Anzai A, Duque-Estrada B, Melo DF, Sternberg F, Santos LDN, et al. Consensus on the treatment of alopecia areata - Brazilian Society of Dermatology. An Bras Dermatol 2020; 95: 39-52.

https://doi.org/10.1016/j.abd.2020.05.006 DOI: https://doi.org/10.1016/j.abd.2020.05.006

Meah N, Wall D, York K, Bhoyrul B, Bokhari L, Sigall DA, et al. The Alopecia Areata Consensus of Experts (ACE) study: results of an international expert opinion on treatments for alopecia areata. J Am Acad Dermatol 2020; 83: 123-130.

https://doi.org/10.1016/j.jaad.2020.03.004 DOI: https://doi.org/10.1016/j.jaad.2020.03.004

Farhangian ME, McMichael AJ, Huang KE, Feldman SR. Treatment of alopecia areata in the United States: a retrospective cross-sectional study. J Drugs Dermatol 2015; 14: 1012-1014.

IBM. IBM MarketScan research databases for life sciences researchers. 2021. [accessed July 29, 2023] Available from https://www.ibm.com/downloads/cas/OWZWJ0QO.

Harries MJ, Sun J, Paus R, King LE, Jr. Management of alopecia areata. BMJ 2010; 341: c3671.

https://doi.org/10.1136/bmj.c3671 DOI: https://doi.org/10.1136/bmj.c3671

Olsen EA, Carson SC, Turney EA. Systemic steroids with or without 2% topical minoxidil in the treatment of alopecia areata. Arch Dermatol 1992; 128: 1467-1473. DOI: https://doi.org/10.1001/archderm.128.11.1467

https://doi.org/10.1001/archderm.1992.01680210045005 DOI: https://doi.org/10.1001/archderm.1992.01680210045005

Samrao A, Fu JM, Harris ST, Price VH. Bone mineral density in patients with alopecia areata treated with long-term intralesional corticosteroids. J Drugs Dermatol 2013; 12: e36-40.

Xu L, Liu KX, Senna MM. A practical approach to the diagnosis and management of hair loss in children and adolescents. Front Med 2017; 4: 112.

https://doi.org/10.3389/fmed.2017.00112 DOI: https://doi.org/10.3389/fmed.2017.00112

Kumaresan M. Intralesional steroids for alopecia areata. Int J Ttrichology 2010; 2: 63-65.

https://doi.org/10.4103/0974-7753.66920 DOI: https://doi.org/10.4103/0974-7753.66920

Lavian J, Li SJ, Lee EY, Bordone LA, Polubriaginof FC, Christiano AM, et al. Validation of case identification for alopecia areata using International Classification of Diseases coding. Int J Trichology 2020; 12: 234.

https://doi.org/10.4103/ijt.ijt_67_20 DOI: https://doi.org/10.4103/ijt.ijt_67_20

Published

2023-08-25

How to Cite

Done, N., Bartolome, L., Swallow, E., Gao, W., Carley, C., Wang, T., & Mostaghimi, A. (2023). Real-World Treatment Patterns among Patients with Alopecia Areata in the USA: A Retrospective Claims Analysis. Acta Dermato-Venereologica, 103, adv12445. https://doi.org/10.2340/actadv.v103.12445

Issue

Section

Articles

Categories

Funding data