Sinclair Dermatology, Consultant Dermatologist, Sinclair Dermatology and Investigator Sinclair Direct, East Melbourne, Australia.
Epworth Dermatology, Richmond; Department of Medicine, University of Melbourne, Sinclair Dermatology, East Melbourne, Australia.
Expert Opin Investig Drugs. 2021 Dec;30(12):1169-1174. doi: 10.1080/13543784.2021.2012149. Epub 2021 Dec 20.
Alopecia areata (AA) is an inflammatory and autoimmune form of hair loss, which can present with one patch of hair loss, but in more extreme cases can lead to total body hair loss. There are limited therapeutic options and no cure, but medication can sometimes induce sustained remission. Disease control cannot be guaranteed; even those who regrow all hair on treatment can experience relapse. There are no FDA approved systemic treatments; therefore, an unmet need for safe, and effective treatments exists. Few treatments have been evaluated by randomized controlled trials. Case reports and series indicate oral Janus Kinase (JAK) inhibitors as a potential therapy. Ritlecitinib is a novel oral JAK3-selective inhibitor being investigated as an AA treatment.
This article introduces ritlecitinib as treatment for AA and considers the mechanism of action, pharmacodynamics, pharmacokinetics, clinical efficacy, and safety [reporting data from a 24-week, phase 2a double-blinded placebo-controlled trial of ritlecitinib in patients with AA who have more than 50% scalp hair loss].
Ritlecitinib offers a novel mode of action, rapid onset, and the capacity for a superior safety profile over other JAK inhibitors. If approved, ritlecitinib will be widely prescribed by physicians overseeing the more severe AA patients for the foreseeable future. As JAK inhibitors regulate the hair growth cycle and have anti-inflammatory effects, the implementation of ritlecitinib in hair loss disorders other than AA, may prove beneficial.
斑秃（AA）是一种炎症性和自身免疫性脱发形式，可能表现为一处脱发，但在更极端的情况下，可能导致全身毛发脱落。治疗选择有限，尚无治愈方法，但药物有时可以诱导持续缓解。无法保证疾病控制；即使那些在治疗后重新长出所有头发的人也可能会复发。没有 FDA 批准的系统性治疗方法；因此，存在对安全有效的治疗方法的未满足需求。很少有治疗方法经过随机对照试验评估。病例报告和系列表明，口服 Janus 激酶（JAK）抑制剂是一种潜在的治疗方法。利特昔替尼是一种新型口服 JAK3 选择性抑制剂，正在作为 AA 治疗方法进行研究。
本文介绍了利特昔替尼作为 AA 的治疗方法，并考虑了其作用机制、药效学、药代动力学、临床疗效和安全性[报告了一项 24 周、2 期、双盲安慰剂对照试验的数据，该试验评估了利特昔替尼在 AA 患者中的疗效，这些患者头皮脱发超过 50%]。
利特昔替尼提供了一种新的作用模式，起效迅速，与其他 JAK 抑制剂相比，具有更好的安全性。如果获得批准，利特昔替尼将在可预见的未来由负责更严重 AA 患者的医生广泛开处方。由于 JAK 抑制剂调节毛发生长周期并具有抗炎作用，因此利特昔替尼在除 AA 以外的脱发疾病中的应用可能会证明是有益的。
