Abstract

BACKGROUND: Effectiveness of ritlecitinib for alopecia areata is unknown in real-world practice. OBJECTIVE: This real-world study aimed to evaluate the effectiveness and safety of ritlecitinib in a heterogeneous cohort of alopecia areata patients and identify response in the scalp as well as lashes, brows, and nails, and clinical predictors of early treatment response. METHODS: We conducted a single-center retrospective cohort study of consecutive patients receiving ritlecitinib 50 mg daily for ≥12 weeks. Disease severity was assessed at baseline and weeks 4, 8, 12, 24, and 36. Treatment-emergent adverse events were systematically recorded. Multivariate logistic regression models assessed the link between treatment response and clinical predictors. RESULTS: The cohort comprised 89 patients (mean age 25.6 ± 13.9 years; 69.7% female). Efficacy outcomes demonstrated temporal progression. The therapeutic efficacy observed in eyelashes, eyebrows, and nails paralleled that of the scalp. Multivariate analysis identified prior Janus kinase inhibitor exposure as an independent predictor of reduced early response. Ritlecitinib demonstrated a favorable safety profile, with no serious adverse events reported throughout the study period. LIMITATIONS: A single-center and Chinese-limited cohort. CONCLUSION: Prior Janus kinase inhibitor exposure is a significant factor influencing early treatment response. Responses of lashes, brows, and nails were similar to the scalp.