For Alan Fletcher and many others, a new alopecia drug is life-changing

“I was fixed with the same challenges that many patients have; hearing, ‘We don’t know what causes it and there’s not much we can do except inject steroids into your scalp and hope for the best’,” she says. “When I started digging around myself, it was very clear there was little known about the genetics of the disease.”

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This was the catalyst for 25 years of research by Christiano and her team at Columbia, amounting to the Food and Drug Administration approval of baricitinib for the treatment of alopecia areata in the United States in June last year.

Now it’s Australia’s turn. After decades of tireless work from Sinclair, Christiano and their respected research teams, the TGA announced the approval of baricitinib for treatment of alopecia areata from May 18, 2023 – a massive breakthrough for Australians living with the condition.

Prior to the discovery of JAK inhibitors as an effective treatment, frequent steroid injections were often the only option available for patients with alopecia areata, many getting between 100 and 200 in their scalp every six weeks. With severe cases such as Fletcher’s, it was rare to see results.

It’s not just the physical toll of recovery that can be difficult – it’s also the emotional one. “People find that when they don’t get job opportunities or they don’t get promotions … they’re always left wondering if it’s because of the way they look,” says Sinclair. “If we get in early, we should be able to help the vast majority of people with these medications.”

According to Sinclair, the common misconception that wearing a wig would solve these insecurities profoundly underestimates the stress caused by the disease.

Christiano has witnessed firsthand what the approval of this drug can mean for patients. “People have been very descriptive [telling me], ‘You gave me my life back, you gave my child their life back’. It’s really a privilege to have had a little to do with getting that in their hands” she says. “It’s such an important part of their identity … Just a little bit of hair growth in crucial areas like the eyebrows can be life-changing.”

The TGA doesn’t approve any JAK inhibitors for use on patients under the age of 18, but Sinclair is finding success trialling them on children as young as 12.

“Response rates are very high in children as they generally have a shorter disease duration,” he says. “In the schoolground, people bully the kids who look different, we’ve got a lot of school avoidance and we even reported on suicide in children as a result of their alopecia areata.”

Fletcher has also encountered this since going public with his diagnosis. “Most people reaching out are the parents of children who have alopecia,” he says. “It’s caused them a great deal of distress”.

When it comes to financial accessibility, the newly approved treatment still has a long way to go. “We’ve got another big step and that’s to convince the government to pay for it because without PBS (Pharmaceutical Benefits Scheme) reimbursement people will be selling their cars and selling their house to get the treatment,” says Sinclair.

“The government already subsidises this drug for a whole range of other diseases – now we’ve got to persuade them that alopecia areata is also worthwhile.”

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