How Upadacitinib Could Expand Options for Severe Alopecia Areata, With Natasha Mesinkovska, MD, PhD

The recent supplemental new drug application (sNDA) submission for upadacitinib (Rinvoq) in severe alopecia areata represents another important step forward for a patient community that had few effective treatment options until just a few years ago, according to Natasha Mesinkovska, MD, PhD, a dermatologist and affiliated expert with the National Alopecia Areata Foundation.^1,2

Speaking with HCPLive, Mesinkovska emphasized the rapid evolution of the alopecia areata treatment landscape since the first FDA approval of a JAK inhibitor for the condition in 2022. She described the progress as the culmination of decades of work by researchers, clinicians, and patient advocates.

“Hair is having its moment,” Mesinkovska said, noting that individuals with alopecia areata historically had limited therapeutic options and often faced the choice of concealing their hair loss or embracing it publicly without effective treatment available.

She highlighted the importance of expanding the number of approved therapies within the JAK inhibitor class, particularly because alopecia areata commonly affects younger individuals. If approved, upadacitinib would provide another treatment option for both adolescents and adults aged 12 years and older, a population with significant unmet needs.

Discussing the phase 3 UP-AA data that supported the submission, Mesinkovska stressed that additional therapies are valuable because patients do not respond uniformly to treatment. She compared the expanding therapeutic armamentarium to having multiple keys available for different locks.

Mesinkovska also noted the study findings reinforce a pattern already observed with JAK inhibitors, namely that higher doses may produce more robust efficacy but can also be associated with a greater likelihood of adverse events. As a result, clinicians must continue balancing efficacy and safety considerations when selecting therapies.

Reflecting on the treatment landscape since the approval of baricitinib, Mesinkovska acknowledged that adoption of newer therapies has been somewhat slower than many specialists initially anticipated. She attributed this to caution among both physicians and patients. Clinicians have sought additional real-world experience with the medications, while some patients with longstanding disease remain hesitant after experiencing previous treatment disappointments.

Nevertheless, she believes confidence in these therapies continues to grow as more patients receive treatment and gain experience with newer options.

Mesinkovska also pointed to what she perceives as an increase in alopecia areata cases following the COVID-19 pandemic, whether due to greater recognition of the disease or potential autoimmune triggers. As awareness and demand for treatment increase, she said additional approved therapies could further strengthen the field and provide patients with greater confidence that meaningful treatment options are available.

Disclosures: Mesinkovska has served on advisory boards for Arena Pharmaceuticals, Concert Pharmaceuticals, La Roche-Posay Laboratorie Pharmaceutique, Lilly ICOS LLC, Nutrafol, and Pfizer Inc.; as a speaker for Eli Lilly; and as an investigator for AbbVie, Arcutis, Inc., Arena Pharmaceuticals, Kyowa Hakko Kirin Pharma, Inc., Lilly ICOS LLC, Merz Aesthetics, and Pfizer Inc. She received honoraria for advisory board and speaking activities, research funding from Merz Aesthetics and Pfizer Inc., and no compensation for investigator roles with AbbVie, Arcutis, Arena Pharmaceuticals, Kyowa Hakko Kirin Pharma, and Lilly ICOS LLC.

References

1. AbbVie. AbbVie submits application to FDA for upadacitinib (Rinvoq) for adults and adolescents with severe alopecia areata. Published April 28, 2026. Accessed June 9, 2026. https://www.prnewswire.com/news-releases/abbvie-submits-application-to-fda-for-upadacitinib-rinvoq-for-adults-and-adolescents-with-severe-alopecia-areata-302754816.html.

2. Smith T. Upadacitinib sNDA Submitted to FDA for Severe Alopecia Areata. HCPLive. April 28, 2026. Accessed June 9, 2026. https://www.hcplive.com/view/upadacitinib-snda-submitted-to-fda-for-severe-alopecia-areata.