BH24 Are we using Janus kinase inhibitors safely and effectively? A regional audit of ritlecitinib prescribing for alopecia areata in North Wales

Abstract

Ritlecitinib is the first licensed Janus kinase (JAK) inhibitor for severe alopecia areata (AA). BAD guidance mandates eligibility, safety screening, outcome monitoring and psychological support. Current data on adherence to these standards remain limited. We aimed to evaluate prescribing, monitoring and clinical outcomes of ritlecitinib in North Wales against BAD guidance. A retrospective audit of all patients prescribed ritlecitinib was performed in North Wales. Data were collected on demographics, Severity of Alopecia Tool (SALT) score, psychological assessment, counselling, pharmacovigilance registration and 36-week outcomes. Compliance with BAD standards and SALT-defined responses was assessed. In total, 17 patients (76% female, 24% male; median age 40.5 years) received ritlecitinib. Only 12% (n = 2) were treatment naive, with the majority having trialled two or more prior therapies before escalation. Baseline SALT was ≥ 50 in 94% (n = 16) and 21–49 in 6% (n = 1); the patient with moderate AA reported significant psychosocial impact. Psychological screening was documented in 65% (n = 11), with 29% (n = 5) referred for psychological support and 82% (n = 14) to wig services. Three out of 17 (18%) had concomitant use of oral minoxidil with ritlecitinib (mean SALT score of 66). Two of these three (67%) subsequently achieved a SALT score < 20 at the week 36 review. Counselling regarding long-term treatment was documented in 47% (n = 8), and no patients were enrolled in a pharmacovigilance registry. At 36 weeks, 12% (n = 2) achieved SALT ≤ 20. Five patients (29%) did not reach week 36, 2 (12%) were not reviewed, 1 discontinued treatment and 1 did not attend follow-up. Ritlecitinib prescribing in North Wales aligned with BAD eligibility guidance and targeted patients with severe AA. However, gaps in governance were identified, including inconsistent documentation of counselling and psychological screening, absence of pharmacovigilance registry enrolment and variable follow-up, which limited outcome capture. These findings highlight the need for a standardized regional ritlecitinib pathway.