BH31 Ritlecitinib for severe alopecia areata: does regional prescribing match national guidance?

Abstract

Ritlecitinib was approved by NICE in March 2024 for treatment of severe alopecia areata (AA), defined as a Severity of Alopecia Tool (SALT) score ≥ 50. Supplementary guidance from the British Hair and Nail Society (BHNS) and the BAD, published in July 2024, provided clarification on eligibility, preinitiation assessment and treatment continuation. Crucially, patients with moderate AA (SALT 21–49) can be reclassified as having severe AA if additional clinical or psychosocial factors are present, and treatment response should be assessed at 36 weeks. A retrospective audit was performed across six regional dermatology centres to evaluate whether ritlecitinib prescribing aligned with NICE and BHNS/BAD guidance. Data were collected using an online pro forma capturing patient demographics, disease severity before and after treatment, initiation and continuation decisions, pretreatment screening and side effects. In total, 57 patients were included. All had severe AA prior to treatment, with three patients reclassified from moderate disease due to additional factors. The mean treatment duration was 12.6 months. Most had alopecia totalis (n = 21) or alopecia universalis (n = 20). Overall, 47% (n = 27) had received at least one prior systemic therapy. Psychological assessment before treatment was documented in 58% (n = 33), most commonly using the Dermatology Life Quality Index. In total, 41 patients had completed 36 weeks of treatment, of whom 21 had not achieved a SALT score ≤ 20. However, of these 21 patients, 52% (n = 11) continued treatment for a further review period (recommended 3 months), while in 38% (n = 8) clinicians diverted from national guidance and continued treatment long term. Most patients reported no adverse events, with stable side-effect rates over time. Overall, regional ritlecitinib prescribing largely aligned with national guidance. However, improvements are needed in psychological assessment and consistent use of SALT scoring at 36 weeks to guide appropriate continuation decisions. By sharing real-world prescribing data we aim to improve clinician confidence and promote guideline-adherent use of ritlecitinib in AA management.