Hair Photography Project: Exploring the Clinical Course of Hair Thinning Associated with Teriflunomide

Background: Teriflunomide is a once-daily oral immunomodulator approved for relapsing-remitting MS. In the phase 3 TEMSO (NCT00134563) and TOWER (NCT00751881) trials, ~13% of patients receiving teriflunomide 14 mg experienced hair thinning compared with ~4% receiving placebo. Hair thinning generally occurred in the first 6 months and resolved without corrective treatment while on teriflunomide (median duration 135 days). Most cases were mild to moderate, and only 6% of teriflunomide patients who reported hair thinning discontinued treatment. Photographs of patients with self-reported hair thinning in a real-world setting could help health care professionals (HCPs) and patients set expectations before starting teriflunomide.

Objectives: To illustrate the clinical course of hair thinning in patients who experience this adverse event (AE) during treatment with teriflunomide.

Methods: Patients who reported hair thinning to HCPs during teriflunomide treatment were eligible. At onset and resolution, HCPs completed hair thinning questionnaires, ranking patient-perceived severity from 0 to 10. With a standardized protocol and camera, patients were photographed from 5 standard views (anterior, posterior, left lateral, right lateral, anterior superior) and an optional manipulated view with hair pulled back.

Results: Of the 31 patients who completed follow-up visits, most were female (30/31), white (28/31), and had no prior history of hair loss (28/31). Average patient age was 51.0 years and mean time to onset of hair thinning was 81 days. Most cases were classified as mild (19/31, 61%), and the rest were moderate (12/31, 39%), with a mean patient severity perception of 4.9/10. On average, follow-up visits took place 268 days (~9 months) after onset of hair thinning. Complete/near-complete resolution or marked improvement was reported in 26/31 patients at follow-up. Four patients discontinued teriflunomide: 3 for other reasons; 1 for AEs including hair thinning. Photographs of patients at onset and follow-up will be presented.

Conclusions: Hair thinning in these patients was consistent with observations from the clinical trial program: cases were usually mild, and most patients recovered fully. As with any potential AE, it is important to ensure appropriate expectations through patient education in advance of treatment.