Effect of Systemic Immunomodulators on Incidence of Alopecia Areata: A Retrospective Cohort Study

This retrospective cohort study investigated the impact of systemic immunomodulators on the incidence of alopecia areata (AA) using data from TriNetX. The study found that patients on leflunomide had a decreased risk of developing AA, with a relative risk (RR) of 0.478. In contrast, methotrexate, cyclosporine, and rituximab were associated with an increased risk of AA, with RRs of 2.192, 3.161, and 1.828, respectively. Other immunomodulators, including azathioprine, mycophenolate mofetil, and several biologics, showed similar risks to healthy controls. These findings suggest that leflunomide may provide a protective benefit against AA, which could influence treatment strategies for patients at risk of developing this condition.