Trial Evaluates Efficacy of Brevilin-A in Treating Pediatric AA

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The clinical variants of alopecia areata (AA) include ophiasis (band-like hair loss in the temporal and occipital areas), alopecia totalis (complete scalp hair loss), and alopecia universalis (total body hair loss). The global prevalence of AA is estimated at around 2%, with increasing incidence estimated among pediatric and adolescent populations.¹ The onset during childhood is often associated with more severe forms of the disease, a poorer prognosis, and a significant negative impact on the quality of life (QoL) for both patients and their families.²

The pathogenesis of AA is multifactorial, involving genetic predispositions and triggers such as psychological stress, leading to an immune response primarily mediated by cytokines like interferon-gamma (IFN-γ) and interleukin-15.³ Traditional treatments for moderate to severe AA include systemic immunosuppressants such as methotrexate and cyclosporine. However, recent advances in therapeutic options, particularly Janus kinase (JAK) inhibitors, offer new avenues for managing this condition. Notably, the FDA approved baricitinib in June 2022 for adults with severe AA, and promising results have emerged from ongoing studies in pediatric populations.⁴

Methods and Materials

With this in mind, a recent study assessed the efficacy and safety of brevilin-A, a topical JAK inhibitor, in treating mild to moderate AA in children and adolescents.⁵ Fifteen patients aged 4 to 17 years were enrolled in the prospective, open-label study at Tor Vergata University Hospital in Rome. All participants had stable AA for at least 6 months and had previously undergone various treatments with suboptimal results. Patients were instructed to apply a lotion containing 0.1% brevilin-A twice daily for 3 months, followed by once daily for an additional3 months. Clinical assessments included the Severity of Alopecia Tool (SALT) and the Children's Dermatology Life Quality Index (CDLQI) to evaluate hair regrowth and QoL.

Results

Researchers reported a mean SALT score of 31 at baseline, indicating moderate disease severity. Over the study period, they stated significant improvements were observed. By the 3-month mark, they reported the mean SALT score to be reduced to 11.2, reflecting notable hair regrowth. At the 6-month assessment, researchers reported 20% of patients achieved complete remission, while 33.3% showed partial improvement. Overall, the study stated that 46.7% exhibited significant clinical and trichoscopic improvement. Alongside these findings, researchers found a statistically significant reduction in CDLQI scores, indicating an enhancement in QoL as a direct result of treatment.

Adverse events were reportedly minimal and primarily consisted of local skin irritation, with no significant systemic adverse events reported. Importantly, researchers stated that brevilin-A's favorable safety profile allows for prolonged use, avoiding the complications often associated with prolonged topical corticosteroid therapy.

Conclusion

The management of alopecia areata, particularly in the pediatric population, requires careful consideration of both clinical and emotional factors. With the promising results demonstrated by brevilin-A, researchers feel there is an opportunity to expand therapeutic options available to this demographic, potentially improving outcomes and QoL.

“The pediatric and adolescent periods constitute a critical phase of fundamental importance for the mental development of a future adult individual, consequently the psychological weight of AA in this category of patients requires a better and more in-depth overview,” the study stated. “In addition to the clinical assessment of pathology through the SALT, the estimate of the emotional impact, for example through the CDLQI of a patient in this age group, should guide the clinical and therapeutic decision-making process. For this reason, there is a need to implement the therapeutic armamentarium, while waiting for topical therapies with guaranteed efficacy and safety.”

Researchers suggested that future studies with larger cohorts and control groups are necessary to validate these findings and further clarify the role of topical JAK inhibitors in the treatment landscape of alopecia areata.

References

1. Lee HH, Gwillim E, Patel KR, et al. Epidemiology of alopecia areata, ophiasis, totalis, and universalis: A systematic review and meta-analysis. J Am Acad Dermatol. 2020;82(3):675-682. doi:10.1016/j.jaad.2019.08.032
2. Prendke M, Kanti-Schmidt V, Wilborn D, et al. Quality of life in children and adolescents with alopecia areata-A systematic review. J Eur Acad Dermatol Venereol. 2023. doi:10.1111/jdv.18848
3. Wang EHC, Sallee BN, Tejeda CI, et al. JAK inhibitors for treatment of alopecia areata. J Invest Dermatol. 2018;138(9):1911-1916.doi:10.1016/j.jid.2018.05.027
4. Bayart CB, DeNiro KL, Brichta L, et al. Topical Janus kinase inhibitors for the treatment of pediatric alopecia areata. J Am Acad Dermatol. 2017;77(1):167-170. doi:10.1016/j.jaad.2017.03.024
5. Matteini E, Diluvio L, Lambiase S, et al. Efficacy and tolerability of brevilin-A, a natural JAK inhibitor, in pediatric alopecia areata: A case series. Clin Cosmet Investig Dermatol. 2024;17:2225-2230
   https://doi.org/10.2147/CCID.S461557