Ritlecitinib

How it works

It irreversibly inhibits JAK3 and TEC kinases, dampening cytokine and cytotoxic T-cell signalling implicated in the autoimmune attack on hair follicles.

Prescribing in practice

• As a JAK inhibitor it carries class warnings for serious infection, venous thromboembolism, major adverse cardiovascular events and malignancy, so assess risk before and during treatment per the MHRA class review.
• Screen for active and latent tuberculosis and viral hepatitis, and ensure age-appropriate vaccinations are up to date before starting.
• Avoid live vaccines during treatment and review concurrent immunosuppression.

Monitoring

Monitor full blood count, lipids and liver function and remain alert for signs of infection, thrombosis or malignancy during treatment.

Counselling the patient

• Report fever, persistent cough or other signs of infection promptly.
• Seek urgent care for symptoms of blood clots such as leg swelling, chest pain or breathlessness.
• Hair regrowth may take several months and benefit may be lost if treatment is stopped.

Evidence & guidelines

Efficacy in severe alopecia areata was demonstrated in the phase 2b/3 ALLEGRO programme.