Ritlecitinib (Litfulo): A New Hope for Severe Alopecia Areata Patients | Dr Anastasia Therianou MD, PhD
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Ritlecitinib (Litfulo): A New Hope for Severe Alopecia Areata Patients

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If you suffer from Alopecia Areata, you are not alone. It is estimated that this hair loss condition impacts one in 1,000 people in the UK alone and over seven million sufferers in the US. Until recently, baricitinib was the only approved medication for the condition, but it was deemed unsuitable to administer to adolescents. However, a recent decision by the National Institute for Health and Care Excellence (NICE) has made ritlecitinib (Litfulo), a Janus kinase (JAK) inhibitor, the second ever approved and legally available treatment for severe Alopecia Areata in patients aged 12 and over.
Clinical trials for ritlecitinib showed that nearly 25% of adults and adolescents saw significant hair regrowth, covering 80% or more of their scalp within 24 weeks. After nearly a year, the response rate in patients increased further, with over 40% of patients achieving 80% or more scalp hair regrowth.
If you are struggling with the effects of Alopecia Areata, here is everything you need to know about ritlecitinib and how it could help you.

Firstly, what is Alopecia Areata?

Alopecia areata occurs when the immune system mistakenly attacks hair follicles, resulting in patches of hair loss. The disease transpires independently of ethnicity, but can often be hereditary. Around 10-25% of patients have a family history of alopecia areata or other autoimmune conditions.
The condition can cause hair loss from any part of the body, but it most predominantly affects the head and face. Fortunately, with early treatment, alopecia areata can be reversed most of the times, though it requires patience. Approximately 80% of people with mild alopecia will experience hair regrowth within a year, even without treatment.
Treatment with ritlecitinib is suitable for people with extensive Alopecia.

How Does Ritlecitinib Work?

Ritlecitinib works by blocking the JAK/STAT pathway in the immune system. Specifically inhibiting enzymes called JAK3 and Tyrosine Kinase. This reduces and improves inflammation around the hair follicles, promoting hair regrowth.

How Do I Take Ritlecitinib?

Ritlecitinib is an oral medication developed by Pfizer. It should be taken as a daily tablet by mouth, with or without food. It is important not to chew, crush, or split the tablet; rather, take the dosage in its entirety with fluids to ensure proper ingestion.
before and after Ritlecitinib

What Makes Ritlecitinib Unique?

Ritlecitinib is the second approved medication for severe Alopecia Areata, following baricitinib. Here’s how it stands out:

What Do Clinical Trials Say?

Clinical trials have demonstrated impressive results:
These outcomes make ritlecitinib a promising option for individuals struggling with severe Alopecia Areata.

How Does Ritlecitinib Compare to Baricitinib?

Feature
Ritlecitinib
Baricitinib
Age Eligibility
12 years and older
18 years and older
Mechanism
JAK3 and Tyrosine Kinase inhibition
General JAK inhibition
Approval Scope
Severe Alopecia Areata
Severe Alopecia Areata
Efficacy
40% achieve 80% hair regrowth
Similar efficacy in clinical trials
Side Effects
Increased risk of infections, rare thrombosis
Similar, with added liver enzyme risks

What Are the Possible Side Effects?

As ritlecitinib is a relatively new medication, the available data is based on studies conducted over the past 3 years. Based off conducted trials, it is known that side effects can include an increased risk of infections, particularly of the upper respiratory system. Rarely, ritlecitinib may cause blockage of blood vessels, known as thrombosis, and there is an unknown risk of malignancy. We recommend discussing these risks with your doctor before starting treatment.
brush with hair loss

Does Ritlecitinib Affect Fertility, Pregnancy, or Breastfeeding?

The impact and safety of ritlecitinib on fertility and pregnancy is not yet fully understood. If you become pregnant while taking ritlecitinib, notify your healthcare provider immediately. The medication stays in the body for only a few hours, so it is generally considered safe to discontinue it once pregnancy is confirmed.
Breastfeeding is not recommended during treatment, and the NHS advises abstaining from breastfeeding at least 14 hours after the last dose.

Can I Drink Alcohol While Taking Ritlecitinib?

Alcohol is not known to directly interact with ritlecitinib, however drinking can exacerbate certain side effects, such as headaches and dizziness. Your doctor may recommend limiting alcohol consumption while undergoing Litfulo treatment. Following NHS guidelines, it is safest to drink no more than 14 units of alcohol per week to minimize potential health risks.

What If I Have Mild Alopecia Areata?

As baricitinib ritlecitinib is only licensed for severe forms of Alopecia Areata, it is not suitable for patients with mild symptoms. However, other treatment options are available, and Dr. Anastasia and her team would be happy to discuss them with you. Please feel free to contact us for more information.

If you would like to discuss this treatment option further, or you want to see what other treatments are available, you can contact Dr Anastasia ‘s Therianou dermatology clinic:

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