Background: Alopecia areata (AA) typically presents as round patches of hair loss (e.g., scalp, eyebrow/eyelash, and body), has an unpredictable disease course, and may relapse and remit. AA is a condition with a lifetime risk of approximately 2% in the global population with an annual incidence rate ranging from 2.53 to 26 per 100,000. This comprehensive systematic review and meta-analysis was performed to determine the safety and efficacy of Ritlecitinib in patients with AA. Methods: A systematic search was conducted in PubMed and Cochrane CENTRAL Library for randomized controlled trials (RCTs). We used mean difference with 95% confidence intervals to assess the effectiveness and odds ratio to assess the safety profile. A total of 65 publications were identified through a database search. Following two stages of screening, we included 13 publications. All the studies were parallel and double-blind RCTs and published between 2020 and 2022. Results: Our analysis revealed a significant reduction in SALT score at week 12 and week 24 of (−17.43 [−24.67 to −10.20]; p < 0.0001) and (−20.95 [−29.01 to −12.89]; p < 0.0001), respectively, in patients treated with Ritlecitinib compared to placebo. Furthermore, a significant improvement in PGIC score at week 24 was observed. Additionally, Ritlecitinib revealed a slightly higher reduction in AASIS score compared to placebo; however, this difference was statistically non-significant. Notably, the Ritlecitinib group experienced a higher frequency of headaches, acne and nasopharyngitis compared to placebo, while the placebo group reported a greater occurrence of serious adverse events compared to the Ritlecitinib group. This higher rate of serious events in the placebo arm could be explained by the placebo effect, although these differences were statistically non-significant. Conclusions: These findings suggest that Ritlecitinib holds promise as an effective treatment for AA with an acceptable safety profile, warranting further investigation in larger cohorts and long-term studies.
Read full abstract