Real-world experience of ritlecitinib for the treatment of alopecia areata from an alopecia clinic in a large tertiary dermatology centre

Alopecia areata (AA) is a hair loss disorder that significantly affects quality of life. Therapeutic options for severe disease have been limited and off-label. Janus kinase (JAK) inhibitors represent a major advance in the treatment landscape. Ritlecitinib (Litfulo®), an inhibitor of JAK3 and the TEC kinases, was approved by NICE for the treatment of severe AA in March 2024. To date, real-world data on treatment access, tolerability and outcomes in the UK have not been reported. We evaluated early real-world experience of ritlecitinib, by assessing compliance with the local initiation pathway, time to starting treatment and patient outcomes. A retrospective audit of electronic health records was conducted for patients receiving ritlecitinib 50 mg once daily at a single centre from December 2024 to January 2026. Quantitative data assessed included baseline characteristics, time to treatment initiation, prior treatments and discontinuation themes. Clinical outcomes, using the Severity of Alopecia Tool (SALT), were assessed for those who had reached week 36 of treatment. In total, 145 patients were initiated as per the local pathway (mean age 34.0 years, SD 14.9; 58.6% female). Of those, 19 (mean baseline SALT 93.3, SD 15.0) had reached 36 weeks of treatment at the time this report was compiled. Seven patients [37%, 95% confidence interval (CI) 16.3–61.6] achieved SALT scores ≤ 20; six (32%, 95% CI 12.6–56.6) achieved SALT scores of 21 to < 100; and six (32%, 95% CI 12.6–56.6) were nonresponders. Five of six nonresponders (83%, 95% CI 35.9–99.6) had AA for > 10 years. No serious adverse effects were reported. Six of 145 patients (4.1%, 95% CI 1.5–8.8) discontinued treatment for other reasons: three (50%, 95% CI 11.8–88.2) due to minor adverse effects and three (50%) due to non-treatment-related reasons. Preliminary clinical outcomes suggest meaningful improvements in hair regrowth, in line with response rates observed in trial data. Time since onset of AA may be a predictor of treatment response. The findings suggest a favourable safety profile; however, more real-world long-term follow-up data are needed to further inform this.

Abstract from Crossref