Alopecia areata (AA) is a multifaceted condition that presents unique challenges for both clinicians and patients. The precise evaluation of treatment results is pivotal in ascertaining the process of various therapeutic strategies. This article explores 3 key clinical outcome assessments (COAs) used in AA: the Severity of Alopecia Tool (SALT), the AA Investigator Global Assessment (AA-IGATM), and the clinician reported outcome (ClinRO) for eyebrow hair loss™ and eyelash hair loss™.
1. Severity of Alopecia Tool (SALT)
The SALT score, introduced in accordance with investigative guidelines by the National Alopecia Areata Foundation, quantifies the extent of hair loss on the scalp. It involves evaluating the amount of scalp surface without hair in 4 specific quadrants (right side, top, left side, back). After applying quadrant-specific multipliers reflecting scalp surface area contribution, the scores are summed to provide an overall measure of total hair loss (maximum score of 100 which corresponds to complete scalp hair loss).
2. AA Investigator Global Assessment (AA-IGA™)
The AA-IGA™ is an assessment of the overall scalp hair loss derived from the SALT score. The AA-IGA score is yielded based on the patient’s SALT score. The scale is numbered from 0, which corresponds to 0% of hair loss (ie, SALT 0), indicating no hair loss, to 4, which corresponds to 95-100% of hair loss (ie, SALT 95-100), indicating very severe hair loss. This categorization process is initiated when the investigator inputs the patient’s SALT score into the Electronic Case Report Form (eCRF).
3. ClinRO for eyebrow hair loss™ and ClinRO for eyelash hair loss™
The ClinRO for eyebrow hair loss™ and the ClinRO for eyelash hair loss™ are to be assessed by the investigator and are comprised of single item, 4-point Likert-type response scales to assess incremental severity of each ClinRO measure.
Table 1. Key AA Top 3 COA Characteristics
| Instrument | ClinRO | PRO | License Requirement | References |
| SALT | ✔ | Yes | Olsen 2004 | |
| AA-IGATM | ✔ | Yes | Wyrwich 2020 | |
| ClinRO for eyebrow hair lossTM and eyelash hair loss™ | ✔ | ✔ | Yes
|
Wyrwich 2020 |
Conclusion
In summary, this article provides a concise overview of three key COAs used in the treatment of AA. These include the SALT and the AA-IGATM, which quantifies the extent of hair loss on the scalp, and the ClinRO for eyebrow hair lossTM and the ClinRO for eyelash hair lossTM, which assesses the severity of hair loss in these specific areas. These tools are crucial in accurately assessing the effectiveness of therapeutic interventions in AA, thereby aiding clinicians in tailoring the most effective treatment plans for their patients.
About the author
Theresa Joseph
A seasoned scientist and medical writing expert, Teresa is dedicated to fostering scientific engagement and enhancing the strategic value of medical affairs and innovation in clinical trials. She seamlessly navigates her roles with a decade-long background in preclinical research across various therapeutic areas.
