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Safety and Efficacy of Ritlecitinib for the Treatment of Patients with Alopecia Areata: A Systematic Review and Meta-Analysis of Controlled Trials

Abstract

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.

Keywords: alopecia areata; controlled trials; meta-analysis; ritlecitinib; systematic review.

 

link:

https://pubmed.ncbi.nlm.nih.gov/40142626/

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Mrs Reshma successfully completed her Bachelor of Science degree in nursing from Kerala University of Health Science, India in 2016. She has more than 7 years of experience in the field of nursing. She has successfully participated in a workshop on objective structured clinical examination at a national level and she has successfully published a research study in knowledge of mothers in the weaning process during her undergraduate degree. Mrs Reshma has served as a medical intensive care nurse at Dr Moopen’s WIMS Medical college (ASTER) in Kerala soon after graduation for a total of three years. She then progressed to serve as a medical surgical nurse at Aspel health care in 2020 for 12 months after which she moved to Dubai, where she started working for two years at One call Doctor Home Health Care in Al Qusais as a registered nurse and medical director. In November 2023, Mrs Reshma joined our team at the Al Rubaie Dermatology Center as registered nurse, and she has done fantastically well in her first year with great feedback from many patients.

Mrs Cruz is one of the most experienced members of our staff with more than 25 years of experience, working in the field of nursing. She is a graduate of St. Paul University Dumaguete in 1997, with a degree of Bachelor of Science in Nursing (BSc Nursing). Soon after graduation, Mrs Cruz took up a post as a junior nurse in the Provincial Hospital located in Dumaguete. She relocated to Dubai in 1999, where she started working at Gulf Medical Center for 3 years and then took up a post at Dr Salah Al-Rubaie Dermatology and Venereology Clinic (now known as Al Rubaie Dermatology Center) in 2003. She is a licensed LASER technician and operates many machines unsupervised including IPL Quantum by Lumenis, Splendor X by Lumenis and Radiofrequency microneedling. Her areas of interest include LASER hair removal, cosmetic and aesthetic dermatology. She is well familiar with all treatments provided at our Center including biological medications used to treat atopic dermatitis, psoriasis and alopecia areata. She is also responsible for provided phototherapy to our patients including through Ultraviolet A, Ultraviolet B and Excimer.

Originally, a dentist by trade, Dr Abeer completed his Bachelor of Dental Surgery (BDS) at the University of Alexandria, Egypt in 1973 before being awarded with the Doctor of Philosophy (PhD) degree in fixed dental prostheses and bridge procedures in 1987. He is the man behind the scenes, ensuring that our services are running up to the standards required and that everyone attending our healthcare facility is leaving with a smile on their face. Dr Abeer has played an important role in developing our new clinic in Jumeirah, as he has applied the final touches to the general design of the facility as well as being instrumental in securing our partnership deals with Esaad and Avène.
Dr Al-Rubaye finished his medical training at the well-known Royal College of Surgeons of Ireland (RCSI-MUB) University in 2015. He has since completed an IHO year at Dubai Health Authority and then started working as a Senior House Officer in core medical specialties at the Royal Wolverhampton NHS Trust where he completed 2 years before achieving Membership of the Royal College of Physicians of the United Kingdom (MRCP-London). He has then served 4 years as a dermatology registrar rotating in New Cross Hospital, Walsall Manor Hospital and Cannock Chase Hospital in the West Midlands during which he completed the Specialty Certificate Examination in Dermatology. Dr Al-Rubaye worked as a senior specialist dermatologist at Health Harmonie Group – Birmingham, regularly doing medical dermatology and surgical dermatology clinics in Birmingham, Stoke and Shrewsbury. He holds a post graduate diploma in clinical dermatology (PGDip-Clinical Dermatology) with Merit from Queens Mary University in London and he has a master’s in clinical dermatology (MSc Clinical Dermatology) with distinction from Cardiff University during which he finished as one of the top students in his class. Dr Al-Rubaye holds the American Board of Aesthetic Medicine and is an expert in LASER treatments, Radiofrequency, BOTOX and non-surgical lip enhancements and facial contouring. He has published more than 15 review articles in international and peer reviewed journals. Dr Al-Rubaye is a regular attender of national and international conferences, and he is a regular presenter at the Dubai World Dermatology and LASER Conference & Exhibition (DUBAI DERMA).

Dr Salah is one of the most distinguished and famous dermatologists in Dubai and highly regarded as the go to skin specialist for complicated cases in this city. He has served as a consultant dermatologist at Rashid Hospital for 20 years during which he trained hundreds of aspiring physicians and dermatologists, many of which continued their careers successfully in the country and internationally. A University of Baghdad graduate originally, Dr Salah continued his career in Egypt where he achieved a diploma in clinical dermatology with distinction followed by a masters in dermatology and an MD Doctorate in dermatology at Cairo University (Kasr Al-Ainy) School of Medicine. He then continued his medical career in New York where he completed a fellowship in dermatopathology at the world renown New York University (NYU) and affiliated hospital. He has published more than 70 different clinical research papers both locally and internationally, as well as hundreds of oral presentations in the United Arab Emirates, France, China, Italy, and the United Kingdom. His areas of interest include biological medications in the treatment of Atopic Dermatitis, Psoriasis and Alopecia Areata. His oral presentations and talks have covered many different topics including LASER’s and genodermatosis as well as chronic dermatological diseases such as Acne vulgaris, Atopic dermatitis, Hair loss, and Psoriasis. Dr Salah has been recognised on an international level and he has been chosen as the “Man of the Year” by the Marquis Who’s Who in the World in 1999 and “Man of the Year” by the Marquis Who’s Who in Science and Engineering from 2000-2001. Dr Al-Rubaie opened the doors to his private practice in Dubai in 2003 and has relocated in 2023 to Jumeirah. He is an active member of the American Academy of Dermatology from 1985 – present and his 3 decades of membership have been valued and rewarded as he is a fellow of the American Academy of Dermatology (FAAD). He has also been a member of the European Academy of Dermatology and Venereology (EADV) for almost 3 decades.