Alopecia Induced by Tumor Necrosis Factor-Alpha Antagonists: Description of 52 Cases and Disproportionality Analysis in a Nationwide Pharmacovigilance Database

The study analyzed 282,590 spontaneous adverse drug reaction reports from the French Pharmacovigilance Database, identifying 1068 cases of alopecia, with 52 cases (4.9%) associated with TNF-α antagonist exposure, including drugs like infliximab, adalimumab, etanercept, and certolizumab. A significant association between TNF-α antagonists and alopecia was found, with a pooled reporting odds ratio of 3.0. The study confirmed a strong link between TNF-α antagonist exposure and the occurrence of alopecia, suggesting a class effect, despite TNF-α's known role in inhibiting hair growth and its implication in alopecia areata pathogenesis. The paradox is that while TNF-α antagonists are used to treat inflammatory diseases, they have been reported to induce alopecia, including alopecia areata. The document concludes that there is a confirmed association between TNF-α antagonist exposure and various types of alopecia.