Head, Biostatistics & Data Science OMNY Health Atlanta, United States
Background: Alopecia Areata (AA) is a common autoimmune disease characterized by nonscarring hair loss, affecting more than 300,000 people in the United States (US). AA can have wide variations in the clinical presentation and significantly impact patient psychology and quality of life. The US Food and Drug Administration recently approved the first systemic treatment (baricitinib) for patients with severe AA. Disease management and treatment patterns may vary widely by disease severity. The clinical detail recorded on severity is important for managing individual patient pharmacotherapy and for researchers to better understand real world treatment outcomes.
Objectives: To characterize AA treatment patterns in the real-world setting by disease severity as measured by percent hair loss ( < 25%, 25-49%, ≥ 50%) on the scalp.
Methods: Outpatient electronic health record data (2017-2022) from 6 specialty dermatology networks in the OMNY Health platform were accessed, and AA patients were selected if they had at least 1 severity assessment. Patients were characterized at first severity assessment. Prescription orders and administrations were associated with each severity assessment if they occurred within 7 days. Percent of patient assessments by severity was calculated for the following therapies or procedures: anthralin, intralesional corticosteroids, oral corticosteroids, oral methotrexate, and baricitinib.
Results: A total of 5,666 patients with 9,633 severity assessments were included (73%/15%/12% < 25%/25-49%/≥ 50%). Distributions of gender (61% female), race (74% white, 13% black, 13% other among known categories), region (55% South, 22% West, 20% Midwest, 3% Northeast), and age (17% ≥ 61 years, 68% 21-60 years, 15% ≤ 20 years) were tabulated. Intralesional corticosteroids tended to be used decreasingly with greater severity (47%/48%/33%). Therapies generally used increasingly with greater severity were baricitinib (0.02%/0.73%/2.6%), oral corticosteroids (0.94%/5.9%/6.1%), oral methotrexate (0.05%/0.48%/1.3%), and anthralin (.05%/.24%/.58%).
Conclusions: Disease management of AA is influenced by severity assessment for many treatment strategies. Intralesional corticosteroids were used more often for less severe disease while systemic therapies were used more often for more severe disease. Further analyses would be helpful to track the uptake of baricitinib as it relates to disease severity as longer follow-up times become available.
