Novel Therapies for Alopecia Areata: The Era of Rational Drug Development

The document from 2018 reviews the historical and contemporary treatments for alopecia areata (AA), an autoimmune condition affecting hair follicles. It notes that traditional treatments like corticosteroids and contact immunotherapy had mixed success and potential side effects. Repurposed drugs, such as TNF antagonists and prostaglandin analogs, showed disappointing results, while treatments for androgenetic alopecia like minoxidil were variably effective. The review emphasizes a shift towards targeted therapies, such as Abatacept, TH2 and TH17 antagonists, and JAK inhibitors, which are based on a deeper understanding of AA's pathophysiology. JAK inhibitors, in particular, have shown a 70% success rate in clinical trials, though relapses occur after treatment cessation. The document concludes that future AA treatments will likely be personalized, and further research into the immune mechanisms of AA is needed. Specific drugs like Apremilast and lipid-lowering agents have shown potential in early studies, while others like Etanercept, Alefacept, and efalizumab were ineffective. Genome-wide association studies have helped identify immune-related genes associated with AA, guiding the development of these novel, targeted therapies.