Raj Chovatiya, MD, PhD: Alopecia Areata Patient Needs, Black Box Warnings for JAK Inhibitors

In his latest HCPLive interview, Raj Chovatiya, MD, PhD, described alopecia areata (AA) therapies and common concerns about JAK inhibitors, drawn from his 2023 Winter Clinical Miami dermatology conference presentation.

Chovatiya is an assistant professor of dermatology and the director of the Center for Eczema and Itch at Northwestern University Feinberg School of Medicine.

The discussion featured in this interview continued to cover his Winter Clinical Miami conference presentation, titled ‘New JAK Inhibitors for the Treatment of Alopecia Areata.’

“Well, first and foremost, for individuals taking the disease and its pathology seriously, oftentimes you get pushback when it comes to stepping up treatment for people, (with some) saying this is some type of cosmetic condition,” he said. “And in many ways that is such a misunderstanding and really an insult to everything we know about this as an autoimmune condition.”

Chovatiya explained the importance of appearance for those with AA, explaining that the condition has profound effects on one’s identity.

“The second is getting people to try something new, dipping their toe into the pool, and then jumping in when it comes to thinking about JAK inhibition as a therapy,” he said. “Something that, despite concerns that may be out there, has largely been proven to be very effective, generally very safe for the right kind of patient, and really a great way to treat this disease that really has no other approved targeted options as well.”

Chovatiya then went into a discussion about some of the common concerns about JAK inhibitors, as well as his thoughts on the matter.

“So I think that it's it's reasonably concerned to be thinking about the class wide box warning labeling that exists across JAK inhibitors, whether topical or oral, those important warning messages right on top of the prescribing information that talk about serious infections, venothrombolic events, major adverse cardiovascular events, malignancy and even death,” he said.

Chovatiya then added his views on specific cases, citing baricitinib treatment for AA cases.

“Now, I think that it's important for us to understand the etiology of where this wording comes from, why it exists, and really taking a look at previous studies, but then focusing on the JAK inhibitor of interest (and) on the disease state of interest,” he explained. “So in the case of baricitinib for alopecia areata, you find that these types of events were largely uncommon and extraordinarily rare.”

He added that infection rates for baricitinib were found to be quite low and that there was not much need for concern with regard to rates of malignancies.

In terms of venothrombolic events, really, there was a singular major adverse cardiovascular event in a patient that had a variety of risk factors (so) it's tough to really make a judgment one way or another on the relationship there,” Chovatiya explained.

To learn more about Chovatiya’s presentations from Winter Clinical Miami, view his HCPLive interview above.