If you suffer from an autoimmune disease called alopecia areata, then you may be in luck! Ritlecitinib is a cutting-edge medication used to treat severe alopecia areata cases. On this page, you’ll find everything you need to know about Ritlecitinib: what is it, is it safe, and how do I get it?
Overview
Ritlecitinib (LITFULO) is a new medication, developed by Pfizer, that is effective at treating severe alopecia areata cases. This medicine is usually taken in tablet form and inhibits the Janus kinase 3 (JAK3) and tyrosine kinase receptors that have been linked with alopecia areata-related hair loss. Research on Ritlecitinib’s efficacy looks promising and this medication will shortly be available through NHS Pathways.
What is Ritlecitinib?
In 2022, Pfizer announced the release of a new drug branded LITFULO. LITFULO (Ritlecitinib) is the first medication of its type and enables hair regrowth for patients suffering from an autoimmune condition called alopecia areata.
It comes as little surprise that Pfizer has been developing Ritlecitinib in clinical trials over the last couple of years. It is estimated that 160 million people across the globe suffer from Alopecia Areata (NORD, 2022), making it a prevalent hair loss condition, alongside pattern hair loss conditions such as MPB and FPB.
According to Pfizer, Ritlecitinib can be taken as a “once-daily oral treatment”, usually in the form of 50mg oral tablets, and is suitable “for individuals 12 years of age and older with severe alopecia areata” (Pfizer, 2023).
Ritlecitinib is called a “Janus Kinase” (JAK) inhibitor, or “Jikinib” for short. JAK inhibitors work by preventing signalling molecules from communicating with immune cells in the body that are responsible for alopecia areata-related hair loss.
Several clinical trials have shown Ritlecitinib to be an effective treatment of severe alopecia. It specifically targets the JAK-3 molecule, which is believed to cause alopecia areata. As Ritlecitinib only targets one JAK molecule, researchers believe this may lead to fewer side effects when taking this medication (Tosti, 2022).
Patients who take Ritlecitinib will not only see an and to their patchy hair loss on the scalp but also see hair regrowth in these areas. In turn, this should leave patients achieving dense and thick scalp hair coverage, negating any signs that the patient has alopecia areata.
Who Can Take Ritlecitinib?
LITFULO, or Ritlecitinib, is eligibile for patients who have a severe case of alopecia areata. Adults and adolescents (12+) are both able to take Ritlecitinib. This is useful alopecia areata usually becomes prevalent in a person’s teens, twenties, or thirties.
Ritlecitinib: the Science Behind How It Works
The science behind Ritlecitinib is complex. However, with some prior explanation as to how alopecia areata causes hair loss, it quickly becomes evident how this medication works and how it can prevent hair loss from occurring.
How Do Alopecia Areata Patients Lose Hair?
Before explaining how Ritlecitinib works, it is first important to understand how alopecia areata patients lose hair, and how this is different to other conditions such as pattern baldness.
Alopecia areata is an autoimmune condition where the immune system attacks hair follicles on the body and/or face. A hair follicle is a delicate structure that is rooted in the top layer of skin. When alopecia areata flares up, this can create inflamed hair pores in concentrated areas on the body, causing hair loss.
Alopecia areata usually causes patchy hair loss, often in the size of a 50p piece, and does not occur in a patterned fashion. As this condition is caused by the immune system it can come and go, meaning hair loss is often only temporary.
Like any autoimmune condition, there are often several reasons why a patient may have a flare-up of alopecia areata. The condition may be triggered by stress, diet, or may just occur naturally. There is little definitive research on this.
In extreme cases, alopecia areata may develop into alopecia totalis (alopecia universalis), which causes total hair loss on the body. As an aside, alopecia barbae is the name given to alopecia areata which occurs in the beard area.
So, this is why drug companies have been working hard to isolate the immune cells and receptors responsible for AA-related hair loss and devise a treatment option for the alopecia areata community to combat this hair loss condition.
How Does Ritlecitinib Combat Alopecia Areata?
Put simply, Ritlecitinib works by altering the body’s chemistry to stop alopecia areata from binding onto hair follicles and causing hair loss. If the malignant immune cells of the hair follicles are prevented from attacking hair follicles, then hair loss cannot occur and significant hair regrowth can take place simultaneously!
One of the common bodily systems associated with autoimmune conditions is Janus Kinase (JAK) enzymes. JAK cells are part of the body’s signalling system to inform the body’s immune cells (lymphocytes) that a foreign entity or cell has entered the body and needs to be dealt with.
From here, immune cells will attack the perceived foreign body (in AA cases, the hair follicle) and neutralise the threat. Usually, this results in inflammation within the body; in alopecia patients, this is what causes scalp hair loss.
Ritlecitinib is called a “JAK inhibitor”. JAK inhibitors prevent the JAK enzymes from communicating with the body’s lymphocytes and stop these immune cells from attacking parts of the body unnecessarily. Alopecia areata has been linked with the JAK-3 enzyme and so Ritlecitinib looks to inhibit this enzyme from functioning.
By preventing JAK 3 Kinase from binding with lymphocytes and attacking the body’s hair follicles, the follicle’s typical hair growth cycle is maintained, preventing unnecessary hair loss from occurring.
Other JAK inhibitors are used to treat different autoimmune conditions, particularly Rheumatoid arthritis. These treatments work in very similar ways to Ritlecitinib, targeting specific JAK enzymes responsible for chronic inflammation in other areas of the body.
How Effective is Ritlecitinib at Treating Severe Alopecia Areata?
Clinical research has shown Ritlecitinib to be extremely effective at treating severe cases of alopecia areata, even alopecia totalis (alopecia universalis).
In a study conducted by Ramirez-Malin et. al (2022), they concluded that “several clinical trials and case studies that have assessed Janus kinase inhibitors have had encouraging results”. Their results showed:
Treatment with Ritlecitinib 50 mg and 30 mg daily for 24 weeks has been shown to induce hair regrowth with a significant proportion of patients reaching SALT 20 (≤20% scalp hair loss) after six months of therapy compared to placebo.
It’s encouraging to see that alopecia patients over the age of 12 years old can now have access to new treatments that can alleviate symptoms of alopecia areata. That being said, more clinical studies need to be conducted on Ritlecitinib (and other JAK inhibitors) to further the treatment’s efficacy, side effects, and long-term effects on the body.
What Are the Side Effects of Ritlecitinib?
As with any medication, side effects may occur. Adults and adolescents who take Ritlecitinib may experience some of the following common side effects:
- headache
- diarrhoea
- acne
- rash
- hives
- inflamed hair pores (folliculitis)
- fever
- eczema
- dizziness
- shingles
- decreased red blood cell counts
- mouth sores and/or redness and swelling of the lining of your mouth
In the USA, the Food and Drug Administration (FDA) has previously issued a warning about JAK inhibitors, stating some serious side effects when treating chronic illnesses. The FDA has found there to be a link between JAK inhibitors, cancer, and/or heart problems (FDA, 2021), so consult with a GP or medical practitioner before taking this medication.
If you experience any of the following side effects, you must consult your GP or medical practitioner as soon as possible.
Is LITFULO (Ritlecitinib) Available for Patients With Alopecia Areata in the UK?
The National Institute for Health and Care Excellence (NICE) has recommended Ritlecitinib as a viable medication for alopecia areata patients in the UK. This means that patients over the age of 12 who have been diagnosed with this autoimmune disease can get this prescription medicine through NHS pathways.
In February 2024, Helen Knight, director of medicines evaluation at NICE, said:
Our committee heard how severe alopecia areata can have a significant impact on people’s health and quality of life. I’m delighted that we are now able to recommend this innovative treatment, the first time a medicine for severe alopecia areata has been recommended by NICE for use in the NHS.
After previously not recommending Ritlecitinib to the NHS in September 2023, over the apparent cost of the medication, Pfizer’s improved discount on the price of the treatment now makes Ritlecitinib a cost-effective and clinically effective medication to give alopecia areata patients.
The expected publication date of NICE’s for authorisation of Ritlecitinib use is 27th March 2024. This means the medication will be available on prescription shortly after this date. You can find more details here.
That being said, many alopecia sufferers still struggle to get a diagnosis for their condition making it difficult to be prescribed medication that can alleviate their hair loss symptoms. On this matter, Sue Schilling, CEO of Alopecia UK, has stated publicly:
Unfortunately, our community faces huge challenges including difficulties in getting a dermatology referral from their GP, unacceptable dermatology waiting times in some areas, and even some NHS Trusts making the decision not to allow dermatology appointments for alopecia patients. Alopecia UK will do what it can, with the limited resources and capacity that we have, to urge key decision-makers within the NHS, to invest more into dermatology services and keep referral pathways open for patients with alopecia areata. The excuse of there being no licensed treatments available has now gone. Patients with alopecia areata deserve better treatment and it is now time they start to receive it.
Whilst Schilling certainly seems compelled by the efficacy of Ritlecitinib to treat severe alopecia areata cases, she outlines some of the prevalent issues facing members of the alopecia areata community. Namely, NHS waiting times, underfunded dermatology services, and difficulties in providing an alopecia diagnosis.
Conclusion
LITFULO, or Ritlecitinib, is a JAK inhibitor medication that can be used as a treatment for severe cases of alopecia areata. It is an effective medication for preventing hair loss. At the same time, there are some concerns over the use of JAK inhibitors more broadly, as they have been linked to severe side effects.
In the UK, Ritlecitinib can be prescribed through the NHS. This means that patients can now be provided with an effective treatment that can aid in regrowing their hair.
