Objectives: Alopecia areata (AA) is an autoimmune disease causing hair follicle damage and resulting in non-scarring hair loss. The study objective was to characterize treatment patterns among adolescent patients with AA in the US who received treatment.

Methods: Patients aged 12-17, having ≥2 claims with AA diagnosis (ICD-10 L63.*) from 10/1/2015 to 3/31/2018, with ≥12 months of continuous enrollment pre- and post-first AA diagnosis (index date), and who initiated AA-related treatments within 30 days post-index, were identified in the IBM MarketScan Commercial & Medicare databases. ICD-10 codes were used to identify two subtypes of AA: alopecia totalis (AT; complete scalp hair loss) and alopecia universalis (AU; complete scalp and body hair loss). First- and second-line (1L/2L) treatments received, mean time on therapy, and proportion of days covered (PDC) during the first post-index year were described overall and by AT/AU status.

Results: Overall, 595 patients with AA were included (mean age 14.5 years, 48.2% female). Of these, 560 (94.1%) were non-AT/AU patients. The most common 1L treatments among patients with AT/AU and non-AT/AU, respectively, were corticosteroids, including injectable (28.6%; 50.7%), topical (25.7%; 27.9%), oral (11.4%; 0.7%), and combination corticosteroid therapy (17.1%; 15.2%). Among these, 71.4% and 58.9% of patients with AT/AU and non-AT/AU, respectively, received 2L treatments, The most common 2L treatments were corticosteroids, including injectable (24.0%; 58.8%), topical (12.0%; 21.5%), oral (16.0%; 3.6%), and combination corticosteroid (16.0%; 9.1%). Mean time on therapy for AT/AU and non-AT/AU was 61.2 and 64.5 days, respectively in 1L; 48.7 and 50.2 days, respectively in 2L. PDC was 41.7% for AT/AU and 33.6% for non-AT/AU.

Conclusion: Injectable corticosteroids were the most common 1L treatments used by adolescents with AA. Frequent use of corticosteroids, despite the treatment burden associated with injections and their poor side-effect profile, indicates a potential unmet need for adolescent patients with AA.