Treatment of Severe Alopecia Areata: RESULTS

16 Feb
2011

Response

Of all the patients, 77.4% (n=24) were classified into the responder group (Table 1). Of these 24 patients, 66.6% (n=16) were cosmetically accep­table responders, and 33.3% (n=8) were satisfactory responders (Fig. 1). The initial response time ranged firom 4 to 9.5 weeks with a mean of 5.4 weeks. The mean dose of methyl prednisone during the maintenance phase was 2.9 mg/day and the dose ranged from 2 to 6 mg/day. The type with the best response was ophiasis, followed in order by patchy AA affecting more than 50% of the scalp, AU and AT/AU. The least responsive type of AA was patchy AA affecting less than 50% of the scalp.

Table 1. Demographic data of 24 patients of the clinical responders

Sex/Age

Extent of AA*

Duration

Initial

response (weeks)

Side effect

MTCf (ng/ml)

Mean CsAT (mg/kg)

MPDS§ (mg/day)

1

M/35

AU

1 year

5

52.1

3.21

4

2

M/10

AU

5 years

4

Hypertrichosis

34.8

2.42

2

3

M/6

AU

1.5 years

8

34.6

2.77

2

4

F/27

AU

2.5 years

4

Hematuria,

143.3

4.46

4

hyperbilirubinemia

5

M/22

AU

7 years

9.5

Hyperbilirubinemia

162.1

4.29

4

6

F/16

AT/AU

7 years

14

58.9

3.18

2

7

F/23

AT/AU

3 years

3.5

Hypertrichosis

126.9

3.37

4

8

M/40

AT/AU

1 year

6

146.8

3.08

2

9

M/16

AT/AU

4 years

6

141.4

3.23

4

10

M/29

S4

1.5 years

4

79.2

3.51

2

11

F/20

S4

16 years

2.5

87.0

3.15

2

12

F/23

S4

6 years

3

Hyperlipidemia

111.6

2.08

2

13

M/22

S4

4 years

6.5

51.5

3.33

6

14

M/15

S4

8 months

5

121.1

2.82

2

15

M/25

S4

2 years

3.5

70.1

2.36

4

16

F/20

S4

16 years

7

Hypercholesterolemia

69.4

2.17

2

17

F/54

S3

2 years

4

108.0

3.24

4

18

M/35

S3

3 years

5

Weakness

109.9

2.41

6

19

F/25

S3

5 years

4

108.9

3.70

2

20

F/16

S3

6 months

6

117.1

3.85

4

21

F/25

S3

1 year

7

22.1

2.13

2

22

F/45

S2

6 months

4

48.2

2.40

2

23

M/17

Ophiasis

4 months

2.5

100.3

2.86

4

24

F/41

Ophiasis

10 years

3

Hypertension

156.2

2.21

2

Of the patients, 22.6% (n=10) were classified into the poor-responder group (Table 2).

Fig. 1. (A) A 10-year-old boy

Fig. 1. (A) A 10-year-old boy with alopecia universalis before and after 24 weeks of treatment. (B) A 23-year-old women with alopecia universalis before and after 24 weeks of treatment. (C) A 35-year-old man with alopecia universalis before and after 24 weeks of treatment. (D) A 16-year-old women with alopecia areata affecting more than 75% of hair loss before and after 24 weeks of treatment.

Trough CsA concentrations in the responders and poor responders

The trough CsA concentrations were determined for all the patients. For the responders, the mean CsA dose for maintenance was 3.0 mg/kg/day (2.5 -3.9 mg/kg/day) and the mean trough concen­tration for an initial response was 88.4 ng/ml (range: 33.4~ 141.4 ng/ml). The mean trough concen­tration of CsA for maintenance was 94.2 ng/ml (range: 22.1 — 156.2 ng/ml). For the poor responders, the mean CsA dose for maintenance was 3.7 mg/kg/day (range: 2.2—6.0 mg/kg/day) and the mean trough concentration was 101.2 ng/ml (range: 39.2 — 178.4 ng/ml). The mean dose of CsA for these two groups showed no statistical differences (p>0.05). For the responders, most patients main tained their hair regrowth with trough CsA concentrations between 50 and 150 ng/ml (Fig. 2). The responders had a lower mean trough concentration than did the poor responders (p<0.05). levitra plus

Table 2. Demographic data of 10 patients of the clinical poor responders

Sex/Age

Extent of AA*

Duration

Side effect

MTCf (ng/ml)

Mean CsAT (mg/kg)

MPDS§ (mg/day)

1

M/10

AU

6 years

Hypertension

52.1

6.00

3

2

M/24

AU

9 months

177.6

3.57

4

3

F/48

AU

3 years

116.0

3.18

3

4

F/30

AT/AU

1.5 years

178.4

3.00

4

5

F/27

AT/AU

7 years

39.2

3.06

4

6

M/30

AT/AU

6.5 years

68.4

2.78

5

7

M/39

S3

6 months

43.8

3.44

6

8

F/40

S3

2 years

Hyperlipidemia

95.9

4.39

4

9

F/52

S3

1 year

122.2

3.85

4

10

F/52

S2

6 months

Hyperlipidemia

118.7

3.57

4

In addition, the mean trough concentration was not related to either the duration of AA (p=0.33) or the extent of AA (p=0.60) for both groups.

Fig. 2. Trough concentration of cyclosporine

Fig. 2. Trough concentration of cyclosporine A in the responders and poor-responders. The mean trough concentration of cyclosporine A in the responders was 94.2 ng/ml (range: 22.1 —162.1 ng/ml) and 101.2 ng/ml (range: 39.2—178.4 ng/ml) in the poor-responders. The responders displayed a lower mean trough concentration than did the poor-responders (p<0.05).

Trough CsA concentration in the patients with and without side effects

In this study, 12 patients showed side effects associated with CsA (Fig. 3), including 4 with hyperlipidemia, 2 with hypertension, 2 with hypertrichosis, 2 with hyperbilirubinemia, 1 with weakness in the lower legs and 1 with hematuria (Table 1, 2). The mean dose of CsA that was used for these two groups showed no statistical differences (p = 0.23). For the group with side effects, the mean CsA concentration measured 195.8 ng/ml (range: 34.8—381.2 ng/ml). The mean concentration of CsA for the patients without side effects was 91.2 ng/ml (range: 22.1—204.8 ng/ml). The difference in the trough CsA concentrations between these two groups was statistically significant (p<0.05).
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Fig. 3. Trough concentration of cyclosporine

Fig. 3. Trough concentration of cyclosporine A in the patients with and without side effects. In the group with side effects, the mean concentration of cyclosporine A was 195.8 ng/ml (34.8 — 381.2 ng/ml). The mean concentration of cyclosporine A in the patients without side effects was 91.2 ng/ml (22.1—204.8 ng/ml). The difference of the trough concentration of cyclosporine A between these two groups was significant (p<0.05).

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