Study Highlights Patient-Driven Risk Tolerance for Ritlecitinib in Severe Alopecia Areata

A new analysis published in The Journal of Dermatology highlights the importance of patient preferences in optimizing treatment strategies for severe alopecia areata (AA). Researchers evaluated the benefit-risk profiles of 2 doses of ritlecitinib—an oral JAK3/TEC kinase inhibitor approved for severe AA—by integrating patient-derived risk tolerance with clinical efficacy and safety data. 

The study employed a discrete-choice experiment (DCE) involving 201 adults with physician-confirmed AA and ≥50% scalp hair loss. Participants assessed benefit attributes, including achieving ≥80% scalp hair coverage and moderate-to-normal eyebrow and eyelash regrowth, alongside risks for serious infection, cancer, and blood clots over 3 years. These data informed the maximum acceptable risk patients would tolerate to achieve increased benefits from the higher dose (50 mg) over the lower dose (30 mg). 

Key findings revealed that patients were willing to accept an absolute increase in 3-year risks of 3.88 percentage points (95% CI, 2.86-4.90) for serious infection, 1.63 percentage points (95% CI, 1.08-2.18) for cancer, and 5.30 percentage points (95% CI, 3.60-7.00) for blood clots to achieve higher probabilities of significant hair regrowth. These risk tolerances align with differences in efficacy between the doses observed in the ALLEGRO-2b/3 clinical trial, supporting the potential for higher dosing in patients prioritizing increased treatment benefits. 

“Patients with severe alopecia areata clearly value the prospect of achieving substantial hair regrowth,” the study authors noted. “These findings suggest that many are willing to accept moderate increases in potential treatment-related risks to maximize efficacy.” 

The results also underscore the utility of the DCE methodology in dose selection for AA treatments. By combining patient preference data with clinical outcomes, this approach may offer a robust framework for personalized treatment planning. 

Ritlecitinib’s demonstrated efficacy in severe AA, paired with this novel analysis of patient-driven risk tolerance, provides critical insight for clinicians navigating treatment decisions. As the authors conclude, “Incorporating patient preferences can enhance shared decision-making and optimize therapeutic outcomes in alopecia areata.” 

Reference
Hauber B, Whichello C, Mauer J, et al. Using patient preference to inform ritlecitinib dose selection for alopecia areata treatment. J Dermatol. Published online January 15, 2025. doi:10.1111/1346-8138.17628