JAK inhibitors ritlecitinib, brepocitinib show promise against alopecia areata

Ritlecitinib and brepocitinib, both Janus kinase (JAK) inhibitors, show promising efficacy for the treatment of alopecia areata (AA), a new trial has found.

The phase IIa, randomized, double-blinded, placebo-controlled trial included AA patients who were treated with ritlecitinib (n=18) or brepocitinib (n=16), and whose outcomes were compared against 12 placebo-treated controls. The primary efficacy endpoint was the 24-week change in Severity of Alopecia Tool (SALT) score. Changes in biomarkers over 24 weeks of follow-up were also evaluated as an exploratory endpoint.

In the ritlecitinib arm, the mean SALT score was 91.2 at baseline, which dropped by 24.9 points by week 24. A similarly large change was reported for brepocitinib-treated patients, whose mean SALT score was 88.4 at baseline and which decreased by 38.8 points after 24 weeks of treatment. In comparison, placebo participants only saw a 7.6-point drop.

Moreover, both JAK inhibitors induced more than 100-percent improvement in the lesional scalp transcriptome by week 24, promoting a nonlesional expression profile.

Comparing both agents showed that 12-week improvements in scalp tissue tended to be greater in the brepocitinib arm. By week 24, however, ritlecitinib had overtaken its comparator and showed greater scalp improvements.

“Results of this study provide further support that treatment with ritlecitinib or brepocitinib is beneficial in the management of patients with AA who have ≥50 percent scalp hair loss,” the researchers said. “Since changes in molecular biomarkers occurred between weeks 12 and 24, it would be of interest to assess whether additional changes occur after 24 weeks.”

“Larger, long-term clinical trials are warranted to evaluate dosage, duration of therapy, safety, and efficacy,” they added.