Objectives: Alopecia areata (AA) is an autoimmune disorder causing destruction of hair follicles resulting in non-scarring hair loss. This study aimed to characterize treatment patterns among adult patients with AA in the US who received treatment.

Methods: Adults with ≥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 initiating 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, 7,703 patients with AA were included (mean age 42.8 years, 62.3% female). Of these, 7,358 (95.5%) were non-AT/AU. The most common 1L treatments among patients with AT/AU and non-AT/AU, respectively, were corticosteroids, including injectable (49.0%; 64.9%), topical (22.0%; 15.7%), oral (4.9%; 0.8%), and combination corticosteroid therapy (15.4%; 14.1%). Among these, 71.9% and 56.8% of patients with AT/AU and non-AT/AU, respectively, received 2L treatment. The most common 2L treatments were corticosteroids, including injectable (42.7%; 62.0%), topical (18.5%; 15.5%), oral (6.0%; 2.9%), and combination corticosteroid therapy (16.5%; 12.6%). Mean time on therapy for AT/AU and non-AT/AU was 65.6 and 77.5 days, respectively, in 1L; 54.1 and 55.6 days, respectively, in 2L. PDC was 40.9% for AT/AU and 36.5% for non-AT/AU.

Conclusion: A majority of adult patients with AA initiated corticosteroids in both 1L and 2L settings. Reliance on corticosteroids, despite the discomfort associated with injections and their poor side-effect profile, suggests an unmet need for patients with AA.