D3.234 - Successful Use of Ritlecitinib in Long-Standing Alopecia Areata with Previous JAK Inhibitor Failure

Alopecia areata (AA) is a chronic autoimmune disorder, and long-term therapy is often required for adequate disease control. However, effective systemic treatment options remain limited for some patients. Ritlecitinib, a selective dual inhibitor of JAK3 and TEC family kinases, has recently been approved for the treatment of AA in adolescents aged ≥12 years.

A 40-year-old woman presented with a longstanding history of AA for 18 years, with significant impairment in quality of life and associated depressive symptoms. She had previously received multiple systemic therapies, including cyclosporine for approximately 17 months, methotrexate for 3–4 years, and intermittent intralesional corticosteroids, either alone or in combination. At presentation, she had >50% scalp hair loss. She was initiated on oral tofacitinib 5 mg twice daily along with intralesional platelet-rich plasma and exosomes, which was continued for 17 months with minimal clinical improvement. Given the suboptimal response, treatment was switched to oral ritlecitinib 50 mg once daily.

At 3-month follow-up, significant hair regrowth was observed in most scalp patches, although eyebrow regrowth was not noted. The patient continues to be followed. No treatment-related adverse events were observed during therapy.

In the pivotal randomized, double-blind, placebo-controlled phase 2b/3 ALLEGRO trial involving adults and adolescents with alopecia areata and ≥ 50% scalp hair loss, once-daily oral ritlecitinib 50 mg was shown to significantly increase the proportion of patients achieving ≤ 20% scalp hair loss at 24 weeks. Treatment with ritlecitinib was also associated with eyebrow and eyelash regrowth. Response rates for key efficacy outcomes were observed to continue to increase with ongoing treatment up to 48 weeks. Ritlecitinib may represent a viable therapeutic option for patients with moderate-to-severe AA who have had an inadequate response to other systemic therapies, including prior JAK inhibitors such as tofacitinib or baricitinib.