Peer-reviewed article
Real-World Systemic Treatment Patterns and Outcomes of Children With Severe Alopecia Areata: A French Nationwide Study (ESTAPED Cohort).
Le Goaziou N, Bodemer C, Labrèze C, Mahé E, Maruani A et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This is a medical study about treating a hair loss condition (alopecia areata) in children in France. It examined different drugs and how long children stayed on each treatment. The study found that most children needed long-term treatment and few achieved remission, with corticosteroids used for flare-ups and methotrexate for ongoing management.
Key points
- 262 children with severe alopecia areata received systemic treatments between 2010-2023
- Intravenous corticosteroids were the most common first-line treatment (35.9%), followed by methotrexate combinations
- Treatment failure was the main reason for stopping treatment (51.9%)
- Only 14.5% of patients achieved remission within 5 years
- No serious adverse events were reported
Limitations
This study focuses on a specific medical condition (alopecia areata) rather than broader child well-being. The findings relate to clinical effectiveness of dermatological treatments rather than child development, health, protection, or participation outcomes.
Abstract
Background/objective Severe forms of alopecia areata (AA) often require off-label systemic treatments (ST) for which data on effectiveness and safety are limited. This study aimed to provide a comprehensive real-world overview of ST patterns in children with severe AA. Method We conducted a retrospective, longitudinal, multicenter study of children with AA (aged <18 years) receiving at least one ST (2010-2023), identified using a keyword search in Ouest Data Hub Warehouse (a hospital data network in France with a critical mass of 5.1 million patients) or by members of the Société Française de Dermatologie Pédiatrique. The primary outcome was drug survival (DS), defined as time on ST, and the secondary outcomes included reasons for treatment discontinuation and long-term observations. Results Among the 262 included children (median age at AA onset: 9 years; 58.4% girls, atopic dermatitis in 32.4%), the first-line ST most frequently initiated (median age: 12 years, alopecia totalis in 28.6%) was intravenous corticosteroids (35.9%, median duration: 3 months), followed by methotrexate + intravenous corticosteroids (24.0%, 12.5 months), oral corticosteroids (17.9%, 1 month), methotrexate (10.7%, 9.5 months), methotrexate + oral corticosteroids (8.8%, 9 months), and lastly baricitinib (2.7%, 2.5 months). Specific maintenance treatments were not significantly associated with DS. Psychological impact, atopic dermatitis, later childhood onset and female sex were associated with longer first-line systemic treatment drug survival. Treatment failure was the main reason for discontinuation (51.9%) and no serious adverse events were reported. Five years after starting the first ST (n = 62), 14.5% of patients had achieved remission. Conclusions In this national, retrospective real-world study, drug survival analyses highlighted two treatment profiles: pulse therapy (corticosteroids) for flare-ups and maintenance treatments (methotrexate, baricitinib) for long-term management. Overall, the effectiveness of therapies appears limited with frequent relapse and a likely need for prolonged treatment. However, data on long-term treatment outcomes of JAKi in children are lacking. This study provides real-life data which could help improve management strategies in children with severe AA.