Presented at the joint International Eczema Council and National Alopecia Areata Foundation Symposium, "Atopic Dermatitis and Alopecia Areata: Comparison and Contrast”, held during the 2019 Annual American Academy of Dermatology meeting in Washington, DC to explore the similarities and differences between these two common but complex skin diseases and the implications from bench to bedside.

1. Therapeutic Advances in Alopecia Areata
Brett King, MD, PhD
Associate Professor of Dermatology
Yale University School of Medicine

2. Disclosures
• Off-label use of medications will be discussed
• I have received honoraria and/or consulting fees from:
Aclaris Therapeutics, Concert Pharmaceuticals, Dermavant
Sciences, Eli Lilly, Pfizer
• I am a clinical trial investigator for:
Concert Pharmaceuticals, Eli Lilly, Pfizer
• I am on a speaker bureau for:
Pfizer, Regeneron, Sanofi Genzyme

3. Alopecia Areata: Treatment
• Intralesional corticosteroids
• Topical corticosteroids
• Topical immunotherapy (e.g. diphenylcyclopropenone, squaric acid)
• Topical minoxidil
• Oral corticosteroids
• Methotrexate
• Cyclosporine
* No reliably effective therapies, especially for severe disease
Strazzulla LC, et al. Alopecia areata: An appraisal of new treatment approaches and overview of current therapies. J Am Acad Dermatol. 2018;78(1):15-24.

4. Baseline 2 months
tofacitinib 5 mg BID
5 months
tofa 10 + 5 mg daily
8 months
tofa 10 + 5 mg daily

5. Ruxolitinib 20 mg BID
Nat Med. 2014;20(9):1043-9.

6. Alopecia Areata: Pathogenesis
Divito SJ, Kupper TS. Nat Med. 2014;20(9):989–90. Based on Xing L, et al. Nat Med. 2014;20(9):1043-9.

7. CytokineSignalingisMediated
byJAK-STATPathway
Janus kinase (JAK) family consists of JAK 1,
JAK 2, JAK 3, and Tyrosine Kinase 2 Vitiligo
cytokine: IFN-g
JAK 1/2
AA
cytokines:
IL-15, IFN-g
JAK 1/2/3
JAK inhibitorJAK inhibitor
Damsky W, King BA. J Am Acad Dermatol. 2017;76(4):736-744.
AD
cytokines: IL-4,
IL-13
JAK 1/3

8. JAmAcadDermatol.
2017;76(1):22-28.
JAmAcad
Dermatol.
2017;76(1):29-32.
JAmAcadDermatol.
2019;80(2):568-9.
Brittany G. Craiglow, MD, and Brett A. King, MD, PhD
New Haven, Connecticut
JAmAcad
Dermatol.
2019;80(2):566-8.
Lucy Y. Liu, MD, and Brett A. King, MD, PhD
New Haven, Connecticut
JAmAcad
Dermatol.
2018;78(2):403-4.

9. JAKi in AA: Clinical Trials
JAK INHIBITOR TARGET
ROUTE OF
ADMINISTRATION PHASE STATUS IDENTIFIER
ATI-501 JAK1/3 oral 2 active, not recruiting NCT03594227
ATI-502 JAK1/3 topical 2 not yet recruiting NCT03759340
baricitinib JAK1/3 oral 2/3 recruiting NCT03570749
CTP-543 JAK1/2 oral 2b/3 not yet recruiting NCT03811912
PF-06651600 JAK3 oral 2b/3 recruiting NCT03732807

10. Other Therapeutic Possibilities?
• Apremilast
• Ustekinumab
• Dupilumab
• Fecal transplant

11. Other Therapeutic Possibilities : Apremilast

12. Other Therapeutic Possibilities: Ustekinumab

13. Other Therapeutic Possibilities: Dupilumab

14. Other Therapeutic Possibilities: Fecal Transplant

15. The Future of AA Treatment
• JAK inhibitors
• Apremilast
• Ustekinumab
• Dupilumab
• Fecal transplant
• Other?

16. Thank you