Authorized in Europe since October and soon marketed under the name Litfulo, a new drug (ritlecitinib) could be a game-changer for patients with severe alopecia (alopecia areata). This autoimmune disease can affect men and women alike. and even children. You should know that 2% of the world’s population develops or will develop an episode of alopecia areata in their lifetime.* It is responsible for inflammation at the roots of the hair and hair, leading to their more or less significant, widespread and lasting fall depending on the individual. Against severe forms, the treatments used until now were not sufficient for all patients. Is ritlecitinib a better alternative? Explanations from dermatologist Philippe Assouly, from the Sabouraud center at Saint-Louis hospital, in Paris.
*Source: (Clinical Review in Allergy & Immunology – Dec. 2021)
A treatment that can be prescribed to adults and children
“By blocking the action of a particular enzyme and protein, the goal of this medication is to limit one of the immune system mechanisms responsible for inflammation around hair follicles.”, explains Dr. Assouly. Reserved for so-called severe cases, with a loss of more than 50% of the hairit comes in the form of tablets to be taken daily and can be prescribed from the age of 12, which is a first.
Important results but only during treatment
In clinical trials, 13.4% of patients achieved 90% scalp coverage after 24 weeks of treatment, compared to 1.5% on placebo. And almost half noticed a moderate or significant improvement at the end of the trial. “The effectiveness is therefore undeniable, but it is limited to the duration of the treatment, tempers Dr. Assouly. Hair falls out a few weeks after stopping the medication.” It would therefore be necessary to take it over the long term to maintain the benefit.
What about the long term effects?
Ritlecitinib is generally well tolerated: rare cases of diarrhea, acne, respiratory infections, hives, skin rashes or dizziness have been reported. “In the long term, questions arise more about the potential increased risk of certain cancers, that the family of drugs to which ritlecitinib belongs (Anti-Jak) could induce”, warns the specialist. For each patient, treatment must therefore be evaluated according to their cancer, vascular or cardiac risk factors, and in the case of smoking.
What are the other alternatives?
For patients not eligible for ritlecitinib, different solutions already exist. Of the topical corticosteroids in lotions, sometimes oral or by injection can thus be administered. Corticosteroid therapy even seems to be the most effective treatment to date, particularly when combined with methotrexate, a drug already used against psoriasis or rheumatoid arthritis. Otherwise, products like anthralin are also more rarely applied locally, to cause irritation accelerating regrowth. Likewise, cutaneous immunotherapy treatment is offered in certain specialized centers.