The edition · Dermatology
Upadacitinib regrew scalp hair in about half of people with severe alopecia areata in two phase 3 trials
Replicate trials of 1399 adults and adolescents reached SALT 20 or less at 24 weeks in 45–55% on drug versus under 4% on placebo. Also: a TYK2/JAK1 inhibitor for the skin of dermatomyositis, how well melanoma risk models perform, and who needs skin surveillance after marrow transplant.
The edition in brief
Today's dermatology edition leads on alopecia areata. In two replicate phase 3 trials (UP-AA1 and UP-AA2) of 1399 people aged 12 to 63 with severe alopecia areata (mean SALT 83.9), upadacitinib 15 mg achieved SALT 20 or less at week 24 in 45.2% and 44.6%, and 30 mg in 55.0% and 54.3%, against 1.5% and 3.4% on placebo; serious adverse events were 1.6%, 2.3% and 0.4%. A prespecified secondary analysis of the phase 3 VALOR trial found brepocitinib 30 mg improved cutaneous dermatomyositis activity from week 4 (CDASI-A difference −3.0) and doubled itch remission (38.3% vs 19.0%). An Australian cohort of up to 43,235 adults aged 45 and over found six published melanoma risk models discriminated modestly (AUC 0.58 to 0.70) and mostly underestimated melanoma numbers. A US prognostic study of 3448 marrow transplant survivors built models that separated high- from low-risk patients well (AUC 0.81 to 0.90): 15-year squamous cell carcinoma incidence was 13.6% in the high-risk group and 3.2% in the low-risk group. The pearl covers screening before a JAK inhibitor, with tuberculosis first in Indian practice.
Brepocitinib cleared dermatomyositis skin disease faster and more often than placebo
Watch for brepocitinib as an option for refractory cutaneous dermatomyositis; it is not yet a reason to change current treatment.
Marrow transplant survivors: simple clinical data separated high from low skin cancer risk
Prioritise skin surveillance for marrow transplant survivors with chronic graft-versus-host disease, irradiation or prior skin cancer.
Published melanoma risk models discriminate only modestly in an independent cohort
Treat melanoma risk scores as a guide to broad risk, not a precise individual estimate.
Before starting a JAK inhibitor, screen for tuberculosis and hepatitis B first
Complete tuberculosis and hepatitis screening before the first dose of any JAK inhibitor.
Upadacitinib in severe alopecia areata: about half reached near-full scalp coverage at 24 weeks
Consider upadacitinib for severe alopecia areata where it is licensed, with infection screening and a baseline SALT score first.
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