Upadacitinib helps restore scalp hair in severe alopecia trials

At week 24, nearly half of the patients taking 15 mg of upadacitinib in two international trials had reached at least 80% scalp-hair coverage. They had reached at least 80% scalp-hair coverage. On the 30 mg dose, the figure rose to more than 54%; among patients given a placebo, it was about 2%.

The results came from UP-AA1 and UP-AA2, two Phase III trials spanning 112 clinical centers in 25 countries and 125 centers in 28 countries. Together, they enrolled 1,399 adolescents and adults with severe alopecia areata, defined here as losing at least 50% of the hair on the scalp. Patients received a daily dose of 15 mg, 30 mg or placebo, with hair growth assessed through week 24 and treatment continuing in a 28-week extension.

Upadacitinib is widely used for rheumatoid arthritis. It belongs to a class called JAK inhibitors, which block Janus kinase proteins involved in the immune signals that drive inflammation. In alopecia areata, the immune system mistakenly attacks healthy tissue around hair follicles; the trials tested whether interrupting that signal could allow hair to grow again.

The gains went beyond the scalp. More than 35% of patients on 15 mg and about 46% on 30 mg achieved at least 90% scalp coverage, compared with roughly 1% on placebo. Between about 13% and 23% of patients on the lower and higher doses, respectively, achieved complete scalp regrowth. Eyebrow and eyelash growth also improved, and participants reported feeling better emotionally and socially.

So what does this change in practice? For adolescents and adults with severe alopecia areata, the results point to a treatment that can produce visible regrowth within eight weeks for some patients, rather than leaving severe cases with few effective options. The limits are equally concrete: the evidence comes from two trials, not a promise that everyone will respond, and the most common side effects included acne, colds, throat irritation and upper respiratory infections. The findings were published in JAMA Dermatology.