Real-World Ritlecitinib Treatment of Severe Alopecia Areata (AA) in the US: Patient Characteristics and Physician Satisfaction

Abstract

Ritlecitinib, a JAK3/TEC family kinase inhibitor, is indicated for severe AA in patients aged ≥12 years in the US. This study describes characteristics of ritlecitinib initiators and treatment satisfaction and success.

Adults ≥18 years with severe/very severe AA at ritlecitinib initiation were selected from the Adelphi Real World AA Disease Specific Programme™. This database is a cross-sectional survey of dermatologists and their AA patients [11/2023–06/2024], capturing demographics, clinical characteristics, treatment history and satisfaction, and AA impact. Subgroup analysis was conducted on patients who initiated ritlecitinib ≤2 months of the survey to assess psychosocial burden around the time of treatment initiation.

123 adults were eligible (mean age: 37.1 years, 57% male, 79% white, and 88% commercial insurance). Mean disease duration was 2.1 years. At ritlecitinib initiation, mean scalp hair loss was 71% (n=93); 73% had worsening AA. Common treatment goals were reducing hair loss (94%), improving quality-of-life (41%), and achieving long-term control (32%) (n=123). Among those who reported reasons for selecting ritlecitinib, the most common factors were its ability to reduce scalp hair loss (38%), reasonable cost-benefit ratio (28%), good overall safety profile (25%), and that it is safe for long-term use (25%). Ritlecitinib treatment duration varied among those with known treatment duration (n=111): <3 months, 33%; 3-6 months, 36%; >6 months, 31%. Among those with treatment line data (n=102), ritlecitinib was the first AA treatment for 46% of patients. Among those treated with prior AA therapies (n=60), 18% received another JAK inhibitor before ritlecitinib. Proportions of patients with hair regrowth increased with treatment duration (<3 months, 49%; 3-6 months, 72%; >6 months, 82%). Physician satisfaction with AA control was 54%, 68%, and 85% after <3, 3-6, and >6 months of ritlecitinib. 89% of patients had improving/stable hair regrowth at the time of the survey. Physicians reported treatment success for 68% in the >6-month group (n=34), but felt it was still too early to tell for 29% of patients. Among recent ritlecitinib initiators (n=26), dermatologists reported 69% of patients learned to cope with their AA; however, 84%, 73%, and 65% still reported moderate/severe embarrassment, frustration, and anxiety due to their AA, respectively.

Despite many patients coping with AA, dermatologists reported substantial emotional and daily life impacts due to AA before initiating ritlecitinib. Ritlecitinib was chosen for efficacy, safety profile, and cost-benefit ratio. Hair regrowth, physician satisfaction, and perceived treatment success increased with treatment duration. While selection bias should be considered, results indicate the importance of sustained treatment for the management of patient expectations.