P129 A multicentre real-world evaluation of ritlecitinib in severe alopecia areata: predictors of treatment response

Abstract

In severe alopecia areata, real-world prognostic factors for treatment response are uncertain. We assessed whether time since disease onset, age, baseline Severity of Alopecia Tool (SALT) score, and eyebrow/eyelash regrowth were associated with treatment success. We analysed a multicentre retrospective cohort of 54 patients with alopecia areata from a regional cohort who had been on ritlecitinib treatment for ≥ 3 months. Treatment outcome was dichotomized as success (defined as a SALT score ≤ 20, n = 14) or nonsuccess (n = 38). Time since onset (years) and baseline SALT score were compared between outcome groups. Eyebrow/eyelash regrowth (yes/no) was compared with treatment success using Fisher’s exact test. Time since onset did not differ significantly between the success and nonsuccess groups (Wilcoxon P = 0.54; mean 12.6 vs. 11.7 years). Linear logistic regression showed no significant association between time since onset and success (odds ratio 1.01 per year). Baseline SALT scores were similar between the success and nonsuccess groups (mean 85.1 vs. 84.5), and were not associated with success on logistic regression (odds ratio 1.001 per SALT point). Eyebrow/eyelash regrowth was present in all successes (11 of 11) and absent regrowth was associated with no successes (0 of 7); Fisher’s exact test suggested an association but did not reach conventional significance (P = 0.07), likely due to sparse numbers. In this cohort, baseline SALT and a linear effect of time since onset were not associated with treatment success. Eyebrow/eyelash regrowth showed a strong directional association with success, although statistical certainty was limited by the sample size. Larger studies are needed to confirm these findings and to clarify potential nonlinear effects of disease duration.