Ritlecitinib for Severe Alopecia Areata: A 24-Week, Multicentre, Real-World Study

Ritlecitinib, an oral selective inhibitor of Janus kinase 3 and the TEC family of kinases, has recently been approved for the treatment of severe alopecia areata, but real-world data are still limited. The aim was to evaluate the effectiveness and tolerability of ritlecitinib 50 mg/day after 24 weeks in patients with severe alopecia areata in clinical practice. We performed an Italian observational, retrospective, multicentre study with 24 weeks of follow-up. Patients ≥ 12 years of age with severe alopecia areata (Severity of Alopecia Tool [SALT] ≥ 50) and a disease duration ≥ 6 months who were candidates for systemic therapy were enrolled. Ritlecitinib 50 mg/day was administered according to national guidelines. The primary endpoint was to evaluate the achievement of SALT ≤ 20 at week 24. Secondary endpoints included achievement of SALT ≤ 10; mean change in SALT; trichoscopic improvement; quality of life; psychological impact; efficacy in eyebrows, eyelashes, and nails; and safety profile. A total of 102 patients were included. At week 24, 40.2% of patients achieved SALT ≤ 20, with a greater response in adolescents (48.6%) than in adults (21.9%). The mean SALT score decreased from 86.2 ± 18.5 to 40.8 ± 37.1. Significant improvements were observed in trichoscopic signs and quality of life. The treatment was also effective on eyebrows, eyelashes, and nails. Adverse events were mild (e.g., acne, headache). Ritlecitinib had to be discontinued in only one case of severe anaemia. In this multicentre real-world study, ritlecitinib 50 mg/day was an effective and well-tolerated treatment option for severe alopecia areata. Alopecia areata is a common autoimmune disease that causes hair loss on the scalp and other parts of the body, such as eyebrows, eyelashes, and body hair. It affects people of any age, including adolescents, and often has a strong psycho-emotional impact, reducing quality of life. A new medication for severe alopecia areata, called ritlecitinib, was approved in 2023. Ritlecitinib is a Janus kinase inhibitor that modulates the immune response involved in the pathogenesis of the disease, promoting hair regrowth. However, data on its efficacy in everyday clinical practice have remained limited. To address this, we carried out a retrospective clinical study in Italy involving 20 university dermatology departments. We evaluated 102 adults and adolescents (≥ 12 years) with severe alopecia areata, treated with ritlecitinib 50 mg/day for 24 weeks. After 6 months of treatment, about 40% of patients had major hair regrowth on the scalp (with 80% of the scalp covered by hair). The treatment worked better in adolescents than in adults (48.6 vs 21.9%). Significant improvements were also noted in eyebrows, eyelashes, nail involvement, and quality of life parameters. Ritlecitinib was generally safe and well tolerated. Adverse effects were mild, and only one patient stopped treatment because of anaemia. Overall, our study showed that ritlecitinib was an effective and safe treatment for severe alopecia areata in real-world practice, particularly among adolescents.