Brepocitinib May Improve Alopecia Areata in Some Patients Unresponsive to Ritlecitinib

One-quarter of patients with alopecia areata who did not respond to treatment with ritlecitinib achieved 30% or more improvement on the Severity of Alopecia Tool (SALT) score after switching to brepocitinib, according to study results published in JID Innovations.

“Although the small number of patients precludes firm conclusions regarding efficacy, the data suggest that some patients with alopecia areata and inadequate response to ritlecitinib after ≥24 weeks show benefit after switching to brepocitinib,” wrote corresponding author Brett King, MD, PhD, of the Yale University School of Medicine, New Haven, Connecticut, and coauthors.

The study focused on a crossover open-label extension that stemmed from the 24-week, double-blind ALLEGRO phase 2a trial, which evaluated the safety and efficacy of ritlecitinib and brepocitinib in patients with alopecia areata. After the initial 24 weeks, patients in the ALLEGRO trial had the option to continue treatment in a 24-week single-blind extension, which was followed by the crossover open-label extension.

The crossover open-label extension included patients who did not achieve 30% or greater improvement from baseline in SALT score by the end of the single-blind extension. The 24-week extension included 18 patients who were switched to brepocitinib, and 5 patients who were switched to ritlecitinib.

Both ritlecitinib and brepocitinib had an acceptable safety and tolerability profile in the crossover open-label extension, according to the study. No new safety risks were observed.

No patients who switched to ritlecitinib achieved at least a 30% improvement from baseline in SALT score or improvement in eyebrow or eyelash assessments, an exploratory efficacy evaluation found.

However, 4 of the 16 patients who switched to brepocitinib achieved a 30% or better improvement in SALT score. Moreover, 4 of 15 patients who switched to brepocitinib showed improvement in eyebrow assessments, and 5 of 12 patients who switched to brepocitinib improved in eyelash assessments.

“Further studies are needed to assess the risk and benefit of switching patients who are unresponsive to ritlecitinib to brepocitinib,” researchers advised.

Reference:
King B, Guttman-Yassky E, Peeva E, et al. Safety and efficacy of ritlecitinib and brepocitinib in alopecia areata: results from the crossover open-label extension of the ALLEGRO phase 2a trial. JID Innov. 2022;2(6):100156. doi:10.1016/j.xjidi.2022.100156