BH07 Early real-world insights from GRASS-UK: pilot data from a prospective alopecia areata register

Abstract

Randomized controlled trials (RCTs) of Janus kinase inhibitors (JAKis), including ritlecitinib, have demonstrated efficacy in alopecia areata (AA). However, strict eligibility criteria limit generalizability, excluding many patients treated in clinical practice. There is a need for structured real-world data to capture disease characteristics, treatment patterns and outcomes beyond clinical trial extension studies. The Global Register of Alopecia Areata Disease Severity and Treatment Safety-UK (GRASS-UK) is a prospective observational register addressing this gap. In its pilot phase, 45 patients have been recruited from two UK centres (Salford Royal Hospital, and Mersey and West Lancashire Hospital). The cohort is predominantly female (71%), with age range 6–73 years, and is largely of White British ethnicity (80%). Nearly half (49%) are aged ≥ 40 years while adolescents (aged 12–20 years) and children (1–11 years) are also represented (11% and 4%, respectively). Disease is long-standing, with 47% reporting AA for ≥ 10 years. Disease severity is high, with 80% having severe or very severe disease (Severity of Alopecia Tool ≥ 50%), including 36% with alopecia totalis or alopecia universalis. Clinically relevant comorbidities are frequently reported, including eczema (18%), thyroid disease (9%), anxiety/depression (9%) and prior malignancy (7%). Previous treatments include systemic immunosuppressants (15%), topical immunotherapy (13%) and JAKis (7%). Current management reflects contemporary practice. Ritlecitinib is used in 44% of patients, with 9% awaiting initiation and 7% receiving another JAKi. Other therapies include systemic immunosuppressants (4%) and diphencyprone (22%). Intralesional or topical corticosteroids are used in 20% and adjunctive minoxidil in 18%. GRASS-UK captures a clinically complex and treatment-experienced population with AA, under-represented in RCTs and extension studies, highlighting the importance of complementary real-world evidence. Early pilot findings demonstrate the feasibility and clinical value of structured national data collection. Expansion into phase I will enhance data completeness and enable longitudinal analyses to better define real-world effectiveness, safety and treatment pathways in AA.