Comparative Effectiveness and Safety of Baricitinib and Ritlecitinib in Severe Alopecia Areata: A Real-World...

Baricitinib and ritlecitinib are approved targeted therapies for severe alopecia areata (AA), but direct comparative real-world data remain limited. This monocentric retrospective study evaluated the treatment profile, effectiveness, and safety of both agents in routine clinical practice.

We included 160 patients with severe AA, defined by a Severity of Alopecia Tool (SALT) score ≥ 50, treated with baricitinib 4 mg (n = 110) or ritlecitinib 50 mg (n = 50). Clinical outcomes were assessed at baseline, week 16, and week 52; week 104 data were available for baricitinib. The primary endpoint was achieving SALT ≤ 20 at week 52. Secondary outcomes included SALT ≤ 20 at weeks 16 and 104, improvement in eyebrow and eyelash involvement assessed using clinician-reported outcome (ClinRO) measures, treatment discontinuation, and safety.

Both treatments were associated with progressive clinical improvement through week 52. SALT ≤ 20 response rates were comparable for baricitinib and ritlecitinib at week 16 (39.6% vs. 36.8%) and increased similarly at week 52 (65.5% vs. 61.5%). Among patients with baseline ClinRO scores ≥ 2, eyelash response was achieved by 40.0% and 41.7% of patients at week 16, increasing to 63.0% and 60.0% at week 52, respectively. Eyebrow response was achieved by 35.1% and 28.6% at week 16 and by 59.4% and 40.0% at week 52, respectively. Discontinuation due to adverse events (AEs) was infrequent in both groups (3.6% vs. 3.1%). Non-severe AEs were more frequent with baricitinib than with ritlecitinib (42.7% vs. 26.0%), mainly driven by weight gain, while no major cardiovascular, thromboembolic, or malignancy-related events were observed.

In this real-world retrospective study, baricitinib and ritlecitinib showed comparable effectiveness through week 52 and favorable safety profiles in patients with severe AA, supporting their role as effective targeted therapies in routine clinical practice.