JAK3/TEC inhibition achieves clinically meaningful responses in AA

High rates of 80% or more scalp hair regrowth were observed with ritlecitinib in most grades of baseline severity of alopecia areata (AA). Apart from patients with a baseline Severity of Alopecia Tool (SALT) score of 95–100, 83–93% of participants achieved this goal after 15 months.

“Ritlecitinib is not just a JAK inhibitor, it is also a TEC inhibitor, and TEC is in the tyrosine kinase family which plays an important immunological role in the pathogenesis of AA,” Dr Athanasios Tsianakas (Fachklinik Bad Bentheim, Germany) explained [1]. Dr Tsianakas presented a post-hoc data analysis of the ongoing, open-label, phase 3 ALLEGRO-LT study (NCT04006457) evaluating the efficacy of ritlecitinib in inducing hair growth in patients with AA.

Besides roll-over participants from phase 2 and 3 trials, new participants with ≥12 years of history of  AA with a ≥25% scalp involvement were eligible for inclusion. This resulted in 449 participants with a mean age of 33 years, 64% women, and a mean SALT score of 74.5. The participants were analysed in 5 different groups of SALT severity at baseline, the most severe group comprising participants with a SALT score of 95 to 100, the latter defined as total loss of scalp hair.

The results showed a continuous decrease in SALT from month 1, with all but the most severe group attaining a median SALT between 1.0 and 2.4 at month 15. The group starting with SALT 95–100, achieved a score of 30.9. The assessment of those with at least 80% (SALT20) and 90% (SALT10) re-growth of hair resulted in similar results: SALT20 was reached by 83.3–93.0%, SALT10 by 73.5–81.0%, apart from the most severe group who achieved between 43.9% and 33.5%, respectively.

Adverse event-induced study or ritlecitinib discontinuation was observed in 4.9% of the participants. Dr Tsianakas highlighted that no opportunistic infections and no cases of deep vein thrombosis were reported. “There were no new symptoms or signs reported, so it seems to be a relatively safe drug,” Dr Tsianakas summarised the safety data on ritlecitinib.

In his conclusion, Dr Tsianakas suggested keeping in mind that starting treatment at more advanced stages of AA could make success more difficult.

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   1. Tsianakas A. Efficacy of ritlecitinib in patients with alopecia areata by extent of hair loss at baseline: post hoc analysis of the phase 3 long-term ALLEGRO-LT study. FC01.1, EADV Congress 2023, 11–14 October, Berlin, Germany.

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Posted on 28 November, 202328 March, 2024