Study Highlights Comorbidities, Treatment Patterns for Alopecia Areata

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A significant disease and economic burden is experienced by alopecia areata patients as well as their associated comorbidities, according to new data, with autoimmune and T-helper 2–mediated immune disorders being the most common comorbidities.¹

These conclusions and others were the results of a new retrospective study led by Anwar Al Hammadi, from the DermaMed Clinic in Dubai, United Arab Emirates (UAE). The research team noted the previous lack of data within the UAE region, specifically related to patterns of treatment, the characteristics of patients, comorbidities, and utilization of healthcare resources.

Hammadi et al. highlighted the prevalence of the inflammatory autoimmune disorder within Saudi Arabia of 2.3%, adding that the mean onset age was 25.6 years.² Alopecia areata patterns were assessed in this UAE study using an e-claims database.

“These data are crucial in assisting policymakers and healthcare professionals in formulating optimal guidelines and bridging knowledge gaps,” the investigators wrote. “Therefore, the current study…was conducted to assess the disease burden, comorbidities, treatment patterns, and specialties involved in the diagnosis of (alopecia areata), as well as to assess (health care resource utilization) in patients with (alopecia areata) in Dubai, UAE.”¹

Background and Design

The investigators implemented data from the Dubai Real-World Database (DRWD) e-claims, with the study having a retrospective longitudinal secondary study design and taking place from January 2014 - June 2022. They defined the index data as the date of a subject’s initial alopecia areata diagnosis within the identification period from 2015 - 2021.

The research team noted that the post-index period covered the year following the index date. All individuals in Dubai covered with private insurance are featured in the DRWD e-claims database, and their information includes insurance-related claims. Given the high number of expatriates living in Dubai, the e-claims data cover a multiethnic population.

Diagnoses and demographic data were detailed, as were medications, procedures, associated services, and consultations. Within the index period, the team assessed participant demographics such as insurance, sex, and nationality among those diagnosed with mild, moderate-to-severe, and other forms of alopecia.

Clinical characteristics and comorbidities were evaluated by the investigators at the time of their diagnoses and throughout subjects’ journeys among those diagnosed with mild and moderate-to-severe disease. They also assessed new and repeat visits each year among those in the overall population.

Three distinct comorbidity groups were utilized by the research team: psychological disorders, immune disorders which are autoimmune and T-helper 2 (Th2)–mediated, and other comorbidities. Treatment patterns, including the percentage of individuals undergoing therapy, were assessed by the team within the post-index period for the mild and moderate-to-severe alopecia subcohorts.

The average time between participants’ initial diagnoses were also evaluated, and the start of treatment was calculated for the subcohorts. Average time to visit dermatologists from the index date, frequency of visits by clinician specialty, and the initial dermatologist meeting were also evaluated among those in the overall study population.

The investigators assessed utilization of healthcare resources and associated costs by visit type, comorbidity groups, and type of activity.

Findings

There were 11,851 individuals with alopecia areata evaluated by the research team, and the team noted there was an average age of 37 years for subjects with mild alopecia and 36 years for those with moderate-to-severe disease. There was a male predominance in the cohort, with 77.6% of mild cases and 60.8% of moderate-to-severe cases being male.

The investigators reported the most common comorbidities of participants with moderate-to-severe alopecia were shown to be autoimmune and T-helper 2–mediated immune disorders. Examples included eczema and contact dermatitis among 62.1% of subjects, atopic dermatitis among 36.1%, and asthma among 36.1%.

All levels of alopecia areata severity were noted as having been prescribed topical steroids. The research team’s analysis of comorbidities demonstrated an additional healthcare resource utilization burden among patients given topical steroids.

Advice on treatment was sought out by the majority of participants. The research team noted that 87.4% of subjects with mild disease and 47.7% of those with moderate-to-severe disease spoke with a dermatologist, often within a single day of their diagnosis.

Financial burden of health care resource use which was median disease-specific was found by the team to be notably higher for psychological comorbidities versus autoimmune and T-helper 2–mediated immune disorders (US $224.99 compared to $103.70, respectively).

“The study findings underscore the need to include these therapies in clinical practice in the UAE, with expanding patient access and insurance reimbursement,” they wrote. “However, long-term analysis throughout the treatment trajectory of AA is warranted for improved clinical outcomes and to reduce the economic burden.”

References

1. ^{Hammadi AA, Parmar NV, Ahmed HM, et al. A retrospective analysis of disease epidemiology, comorbidities, treatment patterns, and healthcare resource utilization of alopecia areata in the United Arab Emirates using claims database. J Dermatol. 2024 Jul 25. Doi: 10.1111/1346-8138.17381. Epub ahead of print. PMID: 39051178.}
2. ^{Alshahrani AA, Al-Tuwaijri R, Abuoliat ZA, Alyabsi M, AlJasser MI, Alkhodair R. Prevalence and clinical characteristics of alopecia areata at a tertiary Care Center in Saudi Arabia. Dermatol Res Pract. 2020;2020:7194270.}