Ritlecitinib also effective in patients with total hair loss

Almost 60% of patients with total hair loss achieved at least 80% regrowth of hair after 24 months of ritlecitinib treatment. Notably, sustained responses in this subgroup of patients were comparable with those in the overall ALLEGRO trial.

Treatment success for alopecia areata (AA) is higher in patients treated early (i.e. as long as hair is still present) [1]. This makes alopecia totalis (AT) and alopecia universalis (AU) difficult-to-treat subtypes of AA. In a subset analysis, Dr Melissa Piliang (Cleveland Clinic, OH, USA) and colleagues assessed the efficacy of ritlecitinib treatment up to 24 months in patients with AT/AU who took part in the ALLEGRO phase 2b study (NCT03732807) and the ongoing, long-term phase 3 ALLEGRO-LT study (NCT04006457) [2].

In the recent ALLEGRO trial, the JAK3/TEC kinase inhibitor ritlecitinib demonstrated efficacy and acceptable safety in patients with AA aged ≥12 years [3]. At week 24, 31% of participants treated with the highest ritlecitinib dose achieved a Severity of Alopecia Tool (SALT) score of 20 or less. In the new analysis, SALT scores were evaluated on an observed or last-observation-carried-forward (LOCF) basis [2]. AT/AU was defined as patients with a SALT score of 100 at baseline.

At month 24, 59.6% of the participants with AT/AU at baseline achieved a SALT score ≤20 in the as-observed analysis (36.1% in the LOCF analysis). Thus, sustained responses in the subgroup of participants with AT/AU were similar to those in the overall trial. Both in the AT/AU and the non-AT/AU population, responses increased over time and were maintained for as long as participants remained on therapy. A SALT score ≤10 was reached by 53.2% of the AT/AU population in the as-observed analysis (31.4% in the LOCF analysis).

Dr Piliang emphasised that a SALT score <10 means that patients have 90% hair regrowth. “A substantial proportion of patients with AT/AU are achieving 90% or more of hair regrowth, so really an excellent response,” she concluded.

Relevant readings:

• JAK3/TEC inhibition achieves clinically meaningful responses in AA (EADV 2023)
• Can ritlecitinib deliver long-term efficacy in alopecia areata? (WCD 2023)
• The rise of JAK inhibitors for alopecia areata (DDD 2023)

1. 
   
   1. King B. S022, 2024 AAD Annual Meeting, 8-12 March, San Diego, USA.
   2. Piliang M. Efficacy of ritlecitinib up to months 24 in patients with alopecia totalis (AT) and alopecia universalis (AU) from the ALLEGRO phase 2b/3 and long-term phase 3 clinical studies. LB1, 2024 AAD Annual Meeting, 8–12 March, San Diego, USA.
   3. King B, et al. Lancet 2023;401: 1518-29.

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Posted on 22 April, 20241 May, 2024