Repurposing Drugs for Alopecia Areata: The Vytorin Experience

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Repurposing Drugs for Alopecia Areata: The Vytorin Experience Antonella Tosti

Transcript of Repurposing Drugs for Alopecia Areata: The Vytorin Experience

Page 1: Repurposing Drugs for Alopecia Areata: The Vytorin Experience

Repurposing Drugs for Alopecia Areata:

The Vytorin Experience

Antonella Tosti

Page 2: Repurposing Drugs for Alopecia Areata: The Vytorin Experience

Simvastatin/ezetimibe in alopecia areata

Statins have an anti

inflammatory and

immunomodulatory

effects that can be of

potential benefit in

autoimmune disorders

Page 3: Repurposing Drugs for Alopecia Areata: The Vytorin Experience

Simvastatin/ezetimibe in alopecia areata

Block IFN-γ-induced

MHC II expression

Suppress T cell

activation/ proliferation

Modulate Jak/Stat

pathway

Page 4: Repurposing Drugs for Alopecia Areata: The Vytorin Experience

Simvastatin/ezetimibe in alopecia areata

First report of described in 2007.

Patient with AU had complete

hair regrowth 1 months after

starting the combination

simvastatin/ezetimibe.

The same patient did not have

regrowth when previously

treated with simvastatin alone

Robins DN. Case reports: alopecia universalis: hair growth following initiation of

simvastatin and ezetimibe therapy. J Drugs Dermatol. 2007 Sep;6(9):946-7.

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Simvastatin/ezetimibe in alopecia areata

Two patients

Also treated with intralesional

steroids

Initial regrowth 3 weeks-6

months

Ali A, Martin JM 4th. Hair growth in patients alopecia areata totalis after

treatment with simvastatin and ezetimibe. J Drugs Dermatol. 2010 Jan;9(1):62-4.

Page 6: Repurposing Drugs for Alopecia Areata: The Vytorin Experience

Simvastatin/ezetimibe in alopecia areata

Small open study

29 enrolled patients, 40% to 70% of scalp involvement

using the North American Hair Research Society (NAHRS)

scale

Simvastatin/ezetimibe 40 mg/10 mg daily for 24 weeks

At baseline and every 8 weeks, global photography and

standard laboratory tests were performed.

Subjects who showed more than 20% hair regrowth on

week 24 using the NAHRS scale were considered positive

responders

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Simvastatin/ezetimibe in alopecia areata

19 patients completed 24 weeks of treatment, and 14 / 19

were responders.

At 24 weeks the 14 responders randomized into 2 groups:

A, 7 of 14 patients continued treatment for 24 weeks

5/7 mantained the regrowth

B, 7 of 14 patients stopped medication

5/7 had a relapse

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Simvastatin/ezetimibe in alopecia areata

Lattouf C, Jimenez JJ, Tosti A, Miteva M, Wikramanayake TC, Kittles C, Herskovitz I,

Handler MZ, Fabbrocini G, Schachner LA. Treatment of alopecia areata with

simvastatin/ezetimibe. J Am Acad Dermatol. 2015 Feb;72(2):359-61.

Statistical analysis showed

positive association between

being on therapy and stable

remission

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Simvastatin/ezetimibe in alopecia areata

Small open study in severe alopecia areata

20 patients older than 18 years, with AA totalis/universalis

or involvement of the scalp greater than 70%

Simvastatin/ezetimibe 40 mg/10 mg daily for 24 weeks

17 (85%) patients completed the study .

Loi C, Starace M, Piraccini BM. Alopecia areata (AA) and treatment with

simvastatin/ezetimibe: Experience of 20 patients. J Am Acad Dermatol. 2016

May;74(5):e99-e100

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Simvastatin/ezetimibe in alopecia areata

Fourteen of 17 (82%) patients had no hair regrowth,

Two (12%) had a transient diffuse hair regrowth followed by

total hair loss in 1 month during the treatment period,

One (6%) patient had a patchy regrowth of pigmented hair

(<20%)

Loi C, Starace M, Piraccini BM. Alopecia areata (AA) and treatment with

simvastatin/ezetimibe: Experience of 20 patients. J Am Acad Dermatol. 2016

May;74(5):e99-e100

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Can topical statins

be an option?

DelCanto GM,Petit VA, Vila Granda A, Alcazar O, Perez CI, Elgart GW,

Schachner LA, Jimenez JJ. Treatment with Simvastatin Decreases pStat1

Levels and Reverses AA in the C3H/HeH Mouse Model. 9th World Congress for

Hair Research, 2015, Miami FL, USA

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Can statins be utilized to prevent relapse ?

48 Mice

24

Heat Treatment

Simvastatin (40 mg/Kg/IP)

24

Heat Treatment

Only

Jimenez et al in press

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Can statins be utilized to prevent relapse ?

Heat treatment

induces protein stress

response“HSPs”

resulting in AA in the

mouse model

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Can statins be utilized to prevent relapse ?

Retrospective study

42 patients with alopecia areata ageing 18 to 72 years

Hair regrowth with other treatments (defined as change in

SALT score > 50%)

Simvastatin/ezetimibe 10/40 added to regimen

Unpublished

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Can statins be utilized to prevent relapse ?

Retrospective study

30 severe AA including ophiasis (8)

12 AT/AU

Treatments : clobetasone propionate 0.05%under

occlusion+ pulse systemic steroids,topical

immunotherapy,anthralin

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Can statins be utilized to prevent relapse ?

Retrospective study

At 6 months :

31/ 42 patients had minimal or no relapses and continued

treatment

At 12 months :

11 of the 31 patients had disease relapse ( mild 5 severe

6) when discontinued treatment for personal reasons or

side effects

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Can statins be utilized to prevent relapse ?

Retrospective study

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Thank you!

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