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. 2022 Jun 23:14:11795735221109674.
doi: 10.1177/11795735221109674. eCollection 2022.

Alopecia in Multiple Sclerosis Patients Treated with Disease Modifying Therapies

Mokshal H Porwal  1 , Amber Salter  2 , Dhruvkumar Patel  3 , Ahmed Z Obeidat  1
Affiliations

Alopecia in Multiple Sclerosis Patients Treated with Disease Modifying Therapies

Mokshal H Porwal et al. J Cent Nerv Syst Dis. .

Abstract

Background: There is currently limited literature addressing the reporting of alopecia in multiple sclerosis (MS) patients treated with disease-modifying therapies (DMTs). Anecdotal reports of hair thinning from patients on various DMTs prompted further investigation of a large database.

Objective: To analyze total reports, source of reporting, age distribution, and sex distribution of alopecia associated with DMTs.

Methods: FDA Adverse Event Reporting System (FAERS) public dashboard and OpenFDA database were analyzed for alopecia reports between January 1, 2009, and June 30, 2020, attributed to usage in MS of FDA approved DMTs. The main outcomes included total reports for each drug, age, sex distribution, and reporting source. OpenFDA data was used for statistical analyses including reporting odds ratios (ROR) and information components.

Results: 8759 alopecia reports were identified among 44 114 adverse events in skin and subcutaneous tissue disorders (19.9%). 3701 (42.3%) with teriflunomide, 1675 (19.1%) with dimethyl fumarate, 985 (11.2%) with natalizumab, 926 (10.6%) with fingolimod, 659 (7.5%) with interferon beta-1a, 257 (2.9%) with glatiramer acetate, 243 (2.8%) with ocrelizumab, 124 (1.4%) with interferon beta-1b, 117 (1.3%) with alemtuzumab, 36 (.4%) with siponimod, 24 (.3%) with cladribine, and 12 (.1%) with rituximab. Reports were mostly made by patients (78.3%) and highest in fifth and sixth decades of life. OpenFDA analyses showed increased ROR (ROR 95% confidence interval) of alopecia in females with teriflunomide (18.00, 17.12-18.93), alemtuzumab (1.43, 1.16-1.76), dimethyl fumarate (1.26, 1.18-1.34), and ocrelizumab (1.28, 1.11-1.49). Increased ROR in males was associated with teriflunomide (24.65, 20.72-29.31).

Conclusion: We identified many reports of alopecia for DMTs in addition to teriflunomide. Within the limitations of the database, increased RORs of alopecia were observed for females treated with alemtuzumab, dimethyl fumarate, and ocrelizumab. The source of reporting was largely driven by female patients. Possible alopecia, even if transient, should be considered during patient education when starting DMTs.

Keywords: Multiple sclerosis; alopecia; disease modifying therapy; hair loss.

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Conflict of interest statement

DECLARATION OF CONFLICTING INTERESTS: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Amber Salter AS receives research funding from the Consortium for Multiple Sclerosis Centers (CMSC), MS Society of Canada, National MS Society, and US Department of Defense, serves on several NIH Data and Safety Monitoring Boards and is on the editorial board for Neurology. Ahmed Z. Obeidat reports that he received personal compensation for participation in scientific advisory boards, steering committees from Alexion pharmaceuticals, Biogen, Bristol Myers Squibb, Celgene, EMD Serono, GW pharma, Genentech, Horizon, Jazz Pharmaceuticals, Novartis, Sanofi/Genzyme, TG therapeutics, Viela Bio. Honorarium for speaking engagements from Alexion pharmaceuticals, Biogen, Bristol Myers Squibb, Celgene, EMD Serono, Genentech, Horizon, MJH life and for other activities from Medscape. Dr. Obeidat serves as a site PI for studies funded (directly paid to Medical College of Wisconsin) by National MS Society and PCORI; Atara biotherapeutics, Biogen, Celgene, Bristol Myers Squibb, EMD Serono, Genentech, and Novartis. And Sub-I on studies funded by AbbVie and Sanofi/Genzyme. Dr. Obeidat serves on the editorial board of the International Journal of MS care.

Figures

Figure 1.
Figure 1.
Percent of alopecia out of all reports under skin and subcutaneous tissue disorders for each DMT.
Figure 2.
Figure 2.
Proportion of report sources concerning alopecia from January 1, 2009 to June 30, 2020 for each multiple sclerosis drug.*Source not specified in 4 reports for teriflunomide, 15 for dimethyl fumarate, 5 for natalizumab, 11 for fingolimod, 10 for interferon beta-1a, 2 for glatiramer acetate, and 2 for interferon beta-1b.
Figure 3.
Figure 3.
(A) Reporting odds ratios of all alopecia reports, (B) reporting odds ratios of male alopecia reports, (C) reporting odds ratios of female alopecia reports.
See this image and copyright information in PMC

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