Key points What were the treatment patterns for alopecia areata (AA) in adults in the US from 2015 to 2020? Findings In this cohort study of 45,483 adults with alopecia areata (AA), based on US medical and pharmaceutical claims data, the most common treatments for AA included intralesional, topical, intramuscular, and oral corticosteroids . Half of the patients were not receiving treatment initially, and almost three-quarters of patients were not receiving treatment at 12 months. Meaning These findings indicate that corticosteroids are the main treatment used for alopecia areata (AA) in adults, with most patients not receiving active treatment 1 year after diagnosis; More studies are needed to understand this lack of treatment. |
Importance
Alopecia areata (AA) is characterized by hair loss ranging from limited areas to more extensive forms, including alopecia totalis (AT) and alopecia universalis (AU).
Consensus for treatment is lacking. Understanding current practice patterns could help identify treatment needs and develop standards of care.
Aim
To review treatment patterns for adults with AA in the US between 2015 and 2020.
Design, environment and participants
This retrospective cohort study used commercially insured drug and pharmacy claims from the IBM MarketScan research database to evaluate adults (≥18 years) recently treated for AA between October 15, 2015 and February 28 of 2020.
Alopecia areata was identified based on having at least 1 diagnosis of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code L63.x.
Patients were required to have at least 365 days of continuous enrollment in the health plan before and after the cohort entry date.
Patients were required to be free of AA diagnosis codes 365 days prior to the cohort entry date. Statistical analyzes were carried out between 2019 and 2023.
Main results and measures
The main results were treatment patterns for all patients with alopecia areata (AA) and subgroups of (1) patients with alopecia totalis (AT) and alopecia universalis (AU) and (2) those seen by a dermatologist on the date of entry to the cohort. The course of longitudinal therapy during the first year after diagnosis was also examined.
Results
The study cohort consisted of 45,483 people (mean [SD] age, 43.8 [14.2] years; 29,903 [65.7%] women).
During the follow-up year, 30,217 patients (66.4%) received at least 1 AA treatment. The most common treatments were intralesional corticosteroids (19,014 [41.8%]), topical (18,604 [40.9%]), intramuscular (17,328 [38.1%]), and oral (9,378 [20.6%]) corticosteroids.
Compared with patients without alopecia totalis (AT) or alopecia universalis (AU), patients with AT or AU had a lower frequency of intralesional steroids (359 [11.1%] vs. 18,655 [44.1%], p < 0.001) and a higher frequency of use of topical corticosteroids (817 [25.4%] vs. 17,787 [42.1%], p < 0.001).
Almost half of the patients (21,489 [47.2%]) did not receive treatment on the day of diagnosis. At the end of 12 months, 32,659 (71.8%) were not receiving any treatment , making no treatment the largest study group.
Conclusions and relevance
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