Современные возможности терапии гнездной алопеции
https://doi.org/10.15690/vsp.v23i6.2825
Аннотация
Гнездная алопеция — хроническое генетически детерминированное воспалительное аутоиммунное заболевание, протекающее с поражением волосяных фолликулов, приводящим к временному или стойкому нерубцовому выпадению волос. Для лечения зарегистрированы ингибиторы янус-киназ, позволяющие персонализировать терапию и повысить ее эффективность за счет купирования симптомов и положительного влияния на качество жизни пациентов. Эта группа препаратов рассматривается в качестве основы терапии тяжелых форм гнездной алопеции. Обсуждается проблема развития рецидивов после отмены ингибиторов янус-киназ, а также безопасность длительной поддерживающей терапии препаратами этого класса.
Ключевые слова
Об авторах
Э. Т. АмбарчянРоссия
Амбарчян Эдуард Тигранович - кандидат медицинских наук, заведующий отделением дерматологии
117593, Москва, Литовский бульвар, д. 1а
тел.: +7 (915) 400-00-02
Раскрытие интересов:
Э.Т. Амбарчян — получение исследовательских грантов от компаний Eli Lilly, Novartis, AbbVie, Pfizer, Amryt Pharma plc, гонораров за научное консультирование от Johnson & Johnson.
В. В. Иванчиков
Россия
Москва
Раскрытие интересов:
Автор статьи подтвердил отсутствие конфликта интересов, о котором необходимо сообщить.
А. Д. Алексеева
Россия
Москва
Раскрытие интересов:
Автор статьи подтвердил отсутствие конфликта интересов, о котором необходимо сообщить.
О. Б. Гордеева
Россия
Москва
Раскрытие интересов:
Автор статьи подтвердил отсутствие конфликта интересов, о котором необходимо сообщить.
Л. С. Намазова-Баранова
Россия
Москва
Раскрытие интересов:
Л.С. Намазова-Баранова — получение исследовательских грантов от фармацевтических компаний «Пьер Фабр», Genzyme Europe B.V., «Астразенека Фармасьютикалз», Gilead / PRA «Фармасьютикал Рисерч Ассошиэйтс СиАйЭс», Teva Branded Pharmaceutical products R&D, «ППД Девелопмент (Смоленск)», «Сталлержен С. А. / Квинтайлс ГезмбХ».
Список литературы
1. Passeron T, King B, Seneschal J, et al. Inhibition of T-cell activity in alopecia areata: recent developments and new directions. Front Immunol. 2023;14:1243556. doi: https://doi.org/10.3389/fimmu.2023.1243556
2. Bertolini M, McElwee K, Gilhar A, et al. Hair follicle immune privilege and its collapse in alopecia areata. Exp Dermatol. 2020;29(8):703–725. doi: https://doi.org/10.1111/exd.14155
3. Амбарчян Э.Т., Иванчиков В.В., Аракелян А.Л. и др. Клинический случай анти-TNF-α индуцированного псориаза и псориатической алопеции у подростка с язвенным колитом // Вопросы современной педиатрии. — 2023. — Т. 22. — № 5. — С. 470–476. — doi: https://doi.org/10.15690/vsp.v22i5.2635
4. Rudnicka L, Trzeciak M, Alpsoy E, et al. Disease burden, clinical management and unmet treatment need of patients with moderate to severe alopecia areata; consensus statements, insights, and practices from CERTAAE (Central/Eastern EU, Russia, Türkiye AA experts) Delphi panel. Front Med (Lausanne). 2024;11:1353354. doi: https://doi.org/10.3389/fmed.2024.1353354
5. Karia SB, De Sousa A, Shah N, et al. Psychiatric morbidity and quality of life in skin diseases: a comparison of alopecia areata and psoriasis. Indust Psychiatr J. 2015;24(2):125. doi: https://doi.org/10.4103/0972-6748.181724
6. Mirzoyev SA, Schrum AG, Davis MDP, Torgerson RR. Lifetime incidence risk of alopecia areata estimated at 2.1% by Rochester Epidemiology Project, 1990-2009. J Invest Dermatol. 2014;134(4):1141–1142. doi: https://doi.org/10.1038/jid.2013.464
7. Tan E, Tay YK, Goh CL, Chin Giam Y. The pattern and profile of alopecia areata in Singapore — a study of 219 Asians. Int J Dermatol. 2002;41(11):748–753. doi: https://doi.org/10.1046/j.1365-4362.2002.01357.x
8. Shellow WV, Edwards JE, Koo JY. Profile of alopecia areata: a questionnaire analysis of patient and family. Int J Dermatol. 1992;31(3):186–189. doi: https://doi.org/10.1111/j.1365-4362.1992.tb03932.x
9. 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: https://doi.org/10.1016/j.jaad.2019.08.032
10. Afford R, Leung AKC, Lam JM. Pediatric Alopecia Areata. Curr Pediatr Rev. 2021;17(1):45–54. doi: https://doi.org/10.2174/1573396316666200430084825
11. Zhou C, Li X, Wang C, Zhang J. Alopecia Areata: an Update on Etiopathogenesis, Diagnosis, and Management. Clin Rev Allergy Immunol. 2021;61(3):403–423. doi: https://doi.org/10.1007/s12016-021-08883-0
12. Hordinsky MK. Overview of alopecia areata. J Investig Dermatol Symp Proc. 2013;16(1):S13–S15. doi: https://doi.org/10.1038/jidsymp.2013.4
13. Chelidze K, Lipner SR. Nail changes in alopecia areata: an update and review. Int J Dermatol. 2018;57(7):776–783. doi: https://doi.org/10.1111/ijd.13866
14. McDonald KA, Shelley AJ, Colantonio S, Beecker J. Hair pull test: evidence-based update and revision of guidelines. J Am Acad Dermatol. 2017;76(3):472–477. doi: https://doi.org/10.1016/j.jaad.2016.10.002
15. Gómez-Quispe H, Muñoz Moreno-Arrones O, Hermosa-Gelbard Á, et al. Trichoscopy in Alopecia Areata. Tricoscopia en la alopecia areata. Actas Dermosifiliogr. 2023;114(1):25–32. doi: https://doi.org/10.1016/j.ad.2022.08.018
16. Rossi A, Muscianese M, Piraccini BM, et al. Italian Guidelines in diagnosis and treatment of alopecia areata. G Ital Dermatol Venereol. 2019;154(6):609–623. doi: https://doi.org/10.23736/S0392-0488.19.06458-7
17. Sibbald C. Alopecia Areata: An Updated Review for 2023. J Cutan Med Surg. 2023;27(3):241–259. doi: https://doi.org/10.1177/12034754231168839
18. Petukhova L, Duvic M, Hordinsky M, et al. Genome-wide association study in alopecia areata implicates both innate and adaptive immunity. Nature. 2010;466(7302):113–117. doi: https://doi.org/10.1038/nature09114
19. Hayran Y, Gunindi Korkut M, Öktem A, et al. Evaluation of HLA class I and HLA class II allele profile and its relationship with clinical features in patients with alopecia areata: a case-control study. J Dermatolog Treat. 2022;33(4):2175–2181. doi: https://doi.org/10.1080/09546634.2021.1937478
20. Moravvej H, Tabatabaei-Panah PS, Abgoon R, et al. Genetic variant association of PTPN22, CTLA4, IL2RA, as well as HLA frequencies in susceptibility to alopecia areata. Immunol Invest. 2018;47(7):666–679. doi: https://doi.org/10.1080/08820139.2018.1480032
21. Paus R, Nickoloff BJ, Ito T. A ‘hairy’ privilege. Trends Immunol. 2005;26(1):32–40. doi: https://doi.org/10.1016/j.it.2004.09.014
22. Ohyama M. What is behind the ‘swarm of bees’ in alopecia areata. Br J Dermatol. 2018;179(5):1023–1024. doi: https://doi.org/10.1111/bjd.17142
23. Gilhar A, Laufer-Britva R, Keren A, Paus R. Frontiers in alopecia areata pathobiology research. J Allergy Clin Immunol. 2019;144(6):1478–1489. doi: https://doi.org/10.1016/j.jaci.2019.08.035
24. Suchonwanit P, Kositkuljorn C, Pomsoong C. Alopecia areata: an autoimmune disease of multiple players. Immunotargets Ther. 2021;10:299–312. doi: https://doi.org/10.2147/ITT.S266409
25. Ito T. Recent advances in the pathogenesis of autoimmune hair loss disease alopecia areata. Clin Dev Immunol. 2013;2013: 348546. doi: https://doi.org/10.1155/2013/348546
26. Pratt CH, King LE Jr, Messenger AG, et al. Alopecia areata. Nat Rev Dis Primers. 2017;3:17011. doi: https://doi.org/10.1038/nrdp.2017.11
27. Wang EHC, Yu M, Breitkopf T, et al. Identification of autoantigen epitopes in alopecia areata. J Invest Dermatol. 2016;136(8): 1617–1626. doi: https://doi.org/10.1016/j.jid.2016.04.004
28. Xing L, Dai Z, Jabbari A, et al. Alopecia areata is driven by cytotoxic T lymphocytes and is reversed by JAK inhibition. Nat Med. 2014;20(9):1043–1049. doi: https://doi.org/10.1038/nm.3645
29. Howell MD, Kuo FI, Smith PA. Targeting the Janus kinase family in autoimmune skin diseases. Front Immunol. 2019;10:2342. doi: https://doi.org/10.3389/fimmu.2019.02342
30. Sardana K. Tyrosine kinases and JAK inhibitors. In: Systemic Drugs in Dermatology. Sardana K, ed. 2nd edn. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd; 2022. pp. 494–499.
31. Sardana K, Bathula S, Khurana A. Which is the Ideal JAK Inhibitor for Alopecia Areata — Baricitinib, Tofacitinib, Ritlecitinib or Ifidancitinib — Revisiting the Immunomechanisms of the JAK Pathway. Indian Dermatol Online J. 2023;14(4):465–474. doi: https://doi.org/10.4103/idoj.idoj_452_22
32. James C, Ugo V, Le Couedic JP, et al. A unique clonal JAK2 mutation leading to constitutive signalling causes polycythaemia vera. Nature. 2005;434(7037):1144–1148. doi: https://doi.org/10.1038/nature03546
33. Furumoto Y, Gadina M. The arrival of JAK inhibitors: advancing the treatment of immune and hematologic disorders. BioDrugs. 2013; 27(5):431–438. doi: https://doi.org/10.1007/s40259-013-0040-7
34. Craiglow BG, King BA. Killing two birds with one stone: oral tofacitinib reverses alopecia universalis in a patient with plaque psoriasis. J Invest Dermatol. 2014;134(12):2988–2990. doi: https://doi.org/10.1038/jid.2014.260
35. Anuset D, Perceau G, Bernard P, Reguiai Z. Efficacy and Safety of Methotrexate Combined with Low- to Moderate-Dose Corticosteroids for Severe Alopecia Areata. Dermatology. 2016;232(2):242-8. doi: https://doi.org/10.1159/000441250
36. Chong JH, Taïeb A, Morice-Picard F, et al. High-dose pulsed corticosteroid therapy combined with methotrexate for severe alopecia areata of childhood. J Eur Acad Dermatol Venereol. 2017;31(11):e476–e477. doi: https://doi.org/10.1111/jdv.14291
37. Droitcourt C, Milpied B, Ezzedine K, et al. Interest of high-dose pulse corticosteroid therapy combined with methotrexate for severe alopecia areata: a retrospective case series. Dermatology. 2012;224(4):369–373. doi: https://doi.org/10.1159/000339341
38. Mascia P, Milpied B, Darrigade AS, et al. Azathioprine in combination with methotrexate: a therapeutic alternative in severe and recalcitrant forms of alopecia areata? J Eur Acad Dermatol Venereol. 2019;33(12):e494–e495. doi: https://doi.org/10.1111/jdv.15834
39. Smith A, Trüeb RM, Theiler M, et al. High Relapse Rates Despite Early Intervention with Intravenous Methylprednisolone Pulse Therapy for Severe Childhood Alopecia Areata. Pediatr Dermatol. 2015;32(4):481–487. doi: https://doi.org/10.1111/pde.12578
40. Kiesch N, Stene JJ, Goens J, et al. Pulse steroid therapy for children‘s severe alopecia areata? Dermatology. 1997;194(4): 395–397. doi: https://doi.org/10.1159/000246159
41. Damsky W, King BA. JAK inhibitors in dermatology: The promise of a new drug class. J Am Acad Dermatol. 2017;76(4):736–744. doi: https://doi.org/10.1016/j.jaad.2016.12.005
42. Kennedy Crispin M, Ko JM, Craiglow BG, et al. Safety and efficacy of the JAK inhibitor tofacitinib citrate in patients with alopecia areata. JCI Insight. 2016;1(15):e89776. doi: https://doi.org/10.1172/jci.insight.89776
43. Honap S, Cookson H, Sharma E, et al. Tofacitinib for the treatment of ulcerative colitis, alopecia universalis, and atopic dermatitis: One drug, three diseases. Inflammation Bowel Dis. 2021;27(2):e13–e14. doi: https://doi.org/10.1093/ibd/izaa243
44. Behrangi E, Barough MS, Khoramdad M, et al. Efficacy and safety of tofacitinib for treatment of alopecia areata in children: A systematic review and meta-analysis. J Cosmet Dermatol. 2022;21(12): 6644–6652. doi: https://doi.org/10.1111/jocd.15425
45. Liu LY, King BA. Tofacitinib for the Treatment of Severe Alopecia Areata in Adults and Adolescents. J Investig Dermatol Symp Proc. 2018;19(1):S18–S20. doi: https://doi.org/10.1016/j.jisp.2017.10.003
46. Scheinberg M, de Lucena Couto Océa RA, Cruz BA, Ferreira SB. Brazilian Experience of the Treatment of Alopecia Universalis with the Novel Antirheumatic Therapy Tofacitinib: A Case Series. Rheumatol Ther. 2017;4(2):503–508. doi: https://doi.org/10.1007/s40744-017-0069-z
47. Murashkin NN, Ambarchian ET, Epishev RV. The National Paediatric Alopecia Areata Registry in Russia: An overview. J Am Acad Dermatol. 2022;87(3 Suppl):AB119. doi: https://doi.org/10.1016/j.jaad.2022.06.509
48. Dillon KL. A Comprehensive Literature Review of JAK Inhibitors in Treatment of Alopecia Areata. Clin Cosmet Investig Dermatol. 2021;14:691–714. doi: https://doi.org/10.2147/CCID.S309215
49. 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: https://doi.org/10.1016/j.jaad.2017.03.024
50. Kwon O, Senna MM, Sinclair R, et al. Efficacy and Safety of Baricitinib in Patients with Severe Alopecia Areata over 52 Weeks of Continuous Therapy in Two Phase III Trials (BRAVE-AA1 and BRAVE-AA2). Am J Clin Dermatol. 2023;24(3):443–451. doi: https://doi.org/10.1007/s40257-023-00764-w
51. Sechi A, Song J, Dell’Antonia M, et al. Adverse events in patients treated with Jak-inhibitors for alopecia areata: A systematic review. J Eur Acad Dermatol Venereol. 2023. doi: https://doi.org/10.1111/jdv.19090
52. Torrelo A, Rewerska B, Galimberti M, et al. Efficacy and safety of baricitinib in combination with topical corticosteroids in paediatric patients with moderate-to-severe atopic dermatitis with an inadequate response to topical corticosteroids: results from a phase III, randomized, double-blind, placebo-controlled study (BREEZE-AD PEDS). Br J Dermatol. 2023;189(1):23–32. doi: https://doi.org/10.1093/bjd/ljad096
53. Ramírez-Marín HA, Tosti A. Evaluating the Therapeutic Potential of Ritlecitinib for the Treatment of Alopecia Areata. Drug Des Devel Ther. 2022;16:363–374. doi: https://doi.org/10.2147/DDDT.S334727
54. Hordinsky M, Hebert AA, Gooderham M, et al. Efficacy and safety of ritlecitinib in adolescents with alopecia areata: Results from the ALLEGRO phase 2b/3 randomized, double-blind, placebo-controlled trial. Pediatr Dermatol. 2023;40(6):1003–1009. doi: https://doi.org/10.1111/pde.15378
55. Roskoski R Jr. Properties of FDA-approved small molecule protein kinase inhibitors: A 2024 update. Pharmacol Res. 2024;200: 107059. doi: https://doi.org/10.1016/j.phrs.2024.107059
56. Bennett M, Moussa A, Sinclair R. Successful treatment of chronic severe alopecia areata with abrocitinib. Australas J Dermatol. 2022;63(2):274–276. doi: https://doi.org/10.1111/ajd.13836
57. Zhang J, Zuo YG. Successful treatment of alopecia universalis with abrocitinib: a case report. J Dermatolog Treat. 2023;34(1):2242706. doi: https://doi.org/10.1080/09546634.2023.2242706
58. Zhao J, Liu L. A case of atopic dermatitis with alopecia universalis in a patient treated with abrocitinib. JAAD Case Rep. 2022;22:99–100. doi: https://doi.org/10.1016/j.jdcr.2022.02.027
59. de Lusignan S, Alexander H, Broderick C, et al. Atopic dermatitis and risk of autoimmune conditions: Population-based cohort study. J Allergy Clin Immunol. 2022;150(3):709–713. doi: https://doi.org/10.1016/j.jaci.2022.03.030
60. Guo H, Cheng Y, Shapiro J, McElwee K. The role of lymphocytes in the development and treatment of alopecia areata. Expert Rev Clin Immunol. 2015;11(12):1335–1351. doi: https://doi.org/10.1586/1744666X.2015.1085306
61. Jabbari A, Sansaricq F, Cerise J, et al. An Open-Label Pilot Study to Evaluate the Efficacy of Tofacitinib in Moderate to Severe Patch-Type Alopecia Areata, Totalis, and Universalis. J Invest Dermatol. 2018;138(7): 1539–1545. doi: https://doi.org/10.1016/j.jid.2018.01.032
62. Pan Y, Kupper TS. Metabolic Reprogramming and Longevity of Tissue-Resident Memory T Cells. Front Immunol. 2018;9:1347. doi: https://doi.org/10.3389/fimmu.2018.01347
63. Wherry EJ, Kurachi M. Molecular and cellular insights into T cell exhaustion. Nat Rev Immunol. 2015;15(8):486–499. doi: https://doi.org/10.1038/nri3862
64. Hu X, Li J, Fu M, et al. The JAK/STAT signaling pathway: from bench to clinic. Signal Transduct Target Ther. 2021;6(1):402. doi: https://doi.org/10.1038/s41392-021-00791-1
65. Wang EHC, Sallee BN, Tejeda CI, Christiano AM. JAK Inhibitors for Treatment of Alopecia Areata. J Invest Dermatol. 2018;138(9): 1911–1916. doi: https://doi.org/10.1016/j.jid.2018.05.027
66. Sardana K, Mathachan SR, Gupta P. Pertinent role of maintenance dose of oral tofacitinib in a child with alopecia totalis with a 2.5-year follow-up on low dose. J Cosmet Dermatol. 2022;21(9):4091–4094. doi: https://doi.org/10.1111/jocd.14726
Рецензия
Для цитирования:
Амбарчян Э.Т., Иванчиков В.В., Алексеева А.Д., Гордеева О.Б., Намазова-Баранова Л.С. Современные возможности терапии гнездной алопеции. Вопросы современной педиатрии. 2024;23(6):516-522. https://doi.org/10.15690/vsp.v23i6.2825
For citation:
Ambarchyan E.T., Ivanchikov V.V., Alekseeva A.D., Gordeeva O.B., Namazova-Baranova L.S. Modern Management Approaches for Alopecia Areata. Current Pediatrics. 2024;23(6):516-522. (In Russ.) https://doi.org/10.15690/vsp.v23i6.2825