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DTB drug review
▼Ritlecitinib for severe alopecia areata

https://doi.org/10.1136/dtb.2024.000014

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    What you need to know

    • Janus kinase (JAK) enzymes are believed to be involved in the development of autoimmune inflammatory conditions such as rheumatoid arthritis, ulcerative colitis and alopecia areata.

    • Ritlecitinib is a JAK inhibitor with anti-inflammatory actions that is licensed for the treatment of severe alopecia areata in adults and adolescents aged ≥12 years.

    • Evidence from one randomised controlled trial has shown that ritlecitinib is more effective than placebo at achieving hair regrowth.

    • Frequently reported adverse reactions include diarrhoea, headache, acne, urticaria, rash folliculitis and dizziness.

    • Risk minimisation materials highlight potential risks of infections, thromboembolic events, major adverse cardiovascular events, malignancy, neurotoxicity and embryofetal toxicity.

    About alopecia areata

    Alopecia areata is an autoimmune disease against hair follicles, characterised by hair loss of the scalp, face and/or body, with nail involvement (eg, pitting or ridging) in 10–15% of cases.1–3 Human skin biopsy specimens from people with alopecia areata show the overexpression of Janus kinase 3 (JAK3) and, to a lesser extent, JAK1 and JAK2, which are involved in promoting inflammation via T cells and cytokines.4

    The prevalence of alopecia areata has been estimated as 0.6% in Europe.5 6 In the UK, the annual incidence was found to be highest in people aged 25–29 years (5.1 per 10 000 males and 4.3 per 10 000 females) and then decreased with age.7 It can affect all ages, races and genders.5 People of Asian ethnicity, and from socially deprived and urban areas are more likely to present with alopecia areata.7 A family history of the condition, or chromosomal disorders such as Down syndrome, may increase the risk of alopecia areata,3 and it may be associated with other autoimmune diseases such as thyroiditis, type 1 diabetes and rheumatoid arthritis.8

    It may be a self-limiting condition, especially in the early stages or where there is <25% hair loss. …

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    Footnotes

    • Provenance and peer review Commissioned; externally peer reviewed.