Utility of Azathioprine, Methotrexate, and Cyclosporine as Steroid-Sparing Agents in Chronic Alopecia Areata: A Retrospective Study of Continuation Rates in 138 Patients

In a retrospective study of 852 patients with chronic alopecia areata (CAA), 138 were treated with steroid-sparing agents (SSAs) such as azathioprine, methotrexate, or cyclosporine between 2002 and 2019. The primary outcome measured was the continuation rate of SSA treatment at 6 and 12 months. Results showed that 66.7% (92/138) of patients continued SSA treatment for at least 12 months, with the highest continuation rate observed in azathioprine users at 75.3% (55/73), followed by cyclosporine users at 60.5% (26/43), and methotrexate users at 50% (11/22). Additionally, a significant proportion of patients required concurrent low-dose prednisolone to maintain remission or promote hair regrowth, with 67.3% of azathioprine users, 63.6% of methotrexate users, and 57.7% of cyclosporine users needing this additional medication. The study also found that treatment was discontinued in 15.9% of patients due to adverse events and in 17.4% due to lack of efficacy. The findings suggest that azathioprine was the most utilized SSA in this clinic and that most CAA patients who start on SSAs continue for at least one year, often with the addition of low-dose prednisolone.