BH17 Bridging the gap: identifying dual-targeting therapies for patients with alopecia areata and coexisting immune-mediated inflammatory diseases

Abstract Alopecia areata (AA) is an autoimmune condition that often coexists with other immune-mediated inflammatory diseases (IMIDs) such as Crohn disease, atopic dermatitis, vitiligo and others. The inflammatory and therapeutic overlap between these conditions offers a unique opportunity for drug repositioning, guiding treatment choices and enabling holistic patient management. However, the limited number of drugs licensed for AA presents a significant challenge. We systematically reviewed current and emerging therapies for AA by analysing clinical trials registered on ClinicalTrials.gov. This was complemented by cross-referencing approved therapeutic options in IMIDs commonly associated with AA, including atopic dermatitis (eczema), psoriasis, Crohn disease, rheumatoid arthritis (RA) and multiple sclerosis. For eczema, therapies such as dupilumab show limited evidence in also treating AA. However, Janus kinase inhibitors, a growing class of treatments, offer promise for both conditions. For instance, baricitinib is licensed for both AD and AA, while upadacitinib is licensed for AD and is currently in phase III trials for AA. Amlitelimab, which targets the OX40 ligand pathway, is currently in phase III clinical trials for atopic dermatitis and in phase II trials for severe AA. In Crohn disease, upadacitinib is licensed and has shown potential in phase III trials for AA. In psoriasis, overlapping therapies include ustekinumab, approved for psoriasis and being studied for AA. As for patients with RA, tofacitinib is approved for moderate-to-severe disease and is also utilized in AA. Abatacept is a cytotoxic T lymphocyte-associated protein 4 (CTLA4) immunoglobin costimulatory modulator that attenuates the activation of T cells and is widely used in RA. AA genome-wide association studies have demonstrated that CTLA4 is a susceptibility gene in AA, and phase II trials with abatacept in AA have shown promising results. As for future directions, the development of cross-specialty IMID multidisciplinary team meetings may be valuable, given the rapid introduction of emerging therapies and the resulting complexity. Additionally, integrating real-world evidence is critical, and registries play an essential role in generating insights into drug safety and efficacy across diverse populations. The Global Registry of Alopecia areata disease Severity and treatment Safety (GRASS) UK is a prospective, multicentre, observational clinical registry designed to create harmonized datasets. These datasets aim to generate high-quality, real-world data on existing and emerging therapies for AA, ultimately improving patient care and outcomes.