A new study by researchers at the New York University School of Medicine has reported an instance of successful treatment for Alopecia Universalis using the antibody adalimumab. The recipient of the treatment was a woman in her thirties.
Adalimumab is a recombinant human IgG1 monoclonal antibody, used as a tumour necrosis factor (TNF) blocking anti-inflammatory drug. Adalimumab is sold under the brand name of Humira and is already used in the treatment of a variety of conditions, including Crohn’s disease, Ulcerative Colitis and - as with tofacitinib, a JAK inhibitor drug recently successfully used for the treatment of Alopecia Universalis in a separate trial - rheumatoid arthritis and plaque psoriasis.
This is the first time Adalimumab has been successfully used to treat Alopecia Universalis. Previously, TNF-a inhibitors have been reported to cause alopecia. Dr Marie C. Leger, MD, PhD, from the Ronald O. Perelman Department of Dermatology, said, “There have been many other case reports in the dermatologic literature of TNF-α inhibitors causing alopecia areata. In contrast, our case report presents a patient who very clearly grew hair on adalimumab”.
According to Dr Leger, results were evident quickly; “our patient responded very quickly with very impressive regrowth within 2 months of initiating therapy, suggesting that an extensive trial may not be necessary”.
In addition to the known side effects of adalimumab such as an increased likelihood of contracting infections given the drug, which is administered via injection, can weaken the immune system. There is also a possibility that the drug could actually worsen, rather than improve, Alopecia Universalis. Dr Leger said; “Of course patients and physicians need to understand both the risks of immunosuppressant therapy as well as the possibility that adalimumab may worsen the alopecia”.
Whilst further trials are clearly needed into the long term suitability of Humira as an effective treatment for Alopecia Universalis, it is worth noting that the drug carries strong health warnings in relation to potentially severe side effects when used in its current remit, for the treatment of various other conditions, as previously mentioned.
These include the risk of contracting serious infections such as tuberculosis (TB), and infections caused by viruses, fungi or bacteria. Some people using Humira have died from these infections. Furthermore, the medication may also increase the likelihood of lymphoma and other cancers. Additional adverse effects of Humira can include hepatitis B infection in those who are already carriers of the virus, allergic reactions, problems of the nervous system, liver or blood, heart failure and some immune reactions.
Funmi Lampejo, Pharmacy Manager at The Belgravia Centre said of the developments, "Research is just beginning to be done into the use of immuno-modulators in these types of autoimmune disease. If it is found that hair regrowth occurs at a lower dose, then the incidence of adverse effects may be lower. That would be a really exciting development in an area where patients have hitherto had very few options".
Whilst there are no proven cures, topical immunotherapy can be used as a form of Alopecia Universalis treatment as it may help to stimulate hair regrowth, however it can have unpleasant side effects. Research into possible hair loss treatments for this condition is on-going with recent breakthroughs leading to clinical trials of potential
Whilst the early stages of Alopecia Areata may respond well to personalised courses of hair loss treatment, depending on the severity of the condition, total hair loss across the body is unfortunately far more difficult to treat. Anyone with Alopecia Universalis concerns should seek medical advice from their GP.
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