Effect of systemic immunomodulators on incidence of alopecia areata: A retrospective cohort study
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Presented at: Society for Investigative Dermatology 2025
Date: 2025-05-07 00:00:00
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Summary: Abstract Body: Alopecia areata (AA) is a chronic, autoimmune dermatological disorder characterized by non-scarring patches of hair loss. Patients with autoimmune disorders have an increased risk of developing AA, and these individuals are often prescribed systemic immunomodulatory therapies to manage their primary disease. The relationship between anti-inflammatory immunomodulators, such as disease-modifying anti-rheumatic drugs (DMARDs) and biologics, on AA incidence is unexplored. We sought to determine the effects of immunomodulators on AA incidence compared to a control population. Using TriNetX, we performed a retrospective observational cohort analysis to calculate the relative risks of AA in patients on DMARDs or biologics for any reason versus a healthy control population not on these medications. Cohorts were propensity score matched based on baseline demographics, obesity, rheumatoid arthritis, Sjogren’s syndrome, psoriasis, Crohn’s disease, ulcerative colitis, and systemic lupus erythematosus. Patients on leflunomide had a decreased risk of developing AA (RR [95% CI] = 0.478 [0.233, 0.981]). Methotrexate (2.192 [1.774, 2.708]), cyclosporine (3.161 [2.376, 4.206]), and rituximab (1.828 [1.162, 2.874]) increased the relative risk of developing AA. Azathioprine (1.38 [0.959, 1.956]), mycophenolate mofetil (1.028 [0.864, 1.224]), apremilast (1.4 [0.6223, 3.151]), etanercept (1.6 [0.726, 3.525]), adalimumab (1.375 [0.915, 2.066]), infliximab (1.1 [0.467, 2.59]), certolizumab pegol (1 [0.416, 2.40]) ustekinumab (1 [0.416, 2.40]), risankizumab (1 [0.416, 2.40]) and secukinumab (1 [0.416, 2.40]) had a similar risk of developing AA as healthy controls. Our findings suggest that leflunomide may offer a protective benefit against AA development, while other immunomodulators may increase the risk. Identifying medications with potential protective benefits for patients at increased risk of AA may impact physicians’ therapeutic choices and treatment strategies. Angela R. Liu<sup>1</sup>, Nada Hentati<sup>1</sup>, Bethany R. Rohr<sup>1, 2</sup> 1. Case Western Reserve University School of Medicine, Cleveland, OH, United States. 2. Dermatology, UH Cleveland Medical Center, Cleveland, OH, United States. Clinical Research: Epidemiology and Observational Research