P146 A multicentre retrospective study evaluating the real-world efficacy and safety of ritlecitinib in the treatment of alopecia areata

Abstract

Alopecia areata (AA) is a T-cell-mediated autoimmune disease characterized by nonscarring hair loss of variable extent. There is no standard treatment for severe AA and access to treatment varies widely. Evidence from clinical trials shows that ritlecitinib is more effective than placebo at improving hair regrowth. Ritlecitinib was approved in March 2024 for use in the UK for those aged > 12 years with severe alopecia areata [Severity of Alopecia Tool (SALT) > 50]. We aimed to (i) characterize the demographics and clinical features of patients started on ritlecitinib, (ii) determine treatment response in terms of the proportion of patients achieving SALT ≤ 20 at serial follow-up visits and (iii) review the safety profile. Patients prescribed ritlecitinib were identified from centralized pharmacy records across four hospital sites. We created a registry of demographics and clinical course. Data analysis was undertaken using Jamovi. We present the first 31 patients established on treatment with ritlecitinib. Their average age was 36 years (range 12–63 years; 15% were adolescents). The female-to-male ratio was 4 : 1. The mean disease duration was 11 years. The mean baseline Dermatology Life Quality Index and SALT were 17 and 84, respectively. Thirteen patients had previously received biologic or systemic treatment. All patients had received ≥ 52 weeks of ritlecitinib. In total, 41% of patients achieved SALT ≤ 20 at week 36, with 21% achieving a SALT score of 0. Overall, our response rate (defined as SALT < 20 at 1 year) was 51%. Treatment response was slow, with only eight patients showing any benefit by week 16. Oral adjuvant therapies (minoxidil, n = 3) were largely reserved for refractory cases. Two patients had treatment interruption owing to transient blood abnormalities or infection. There were no serious adverse events. Our real-world data show encouraging early results for both safety and efficacy. Time to treatment response is an important consideration. International AA registries will play a crucial future role, particularly regarding un­answered questions regarding predictors of response and treatment duration.