International journal of dermatology · 2026
Early On-Treatment Change in SALT as a Pragmatic Predictor of Ritlecitinib Response in Moderate-To-Severe Alopecia Areata: A Real-World Cohort Study.
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Gallo Giuseppe, di Corteranzo Isotta Giunipero, Quaglino Pietro, Ribero Simone, Rosset Francois
Аннотация
BACKGROUND: Ritlecitinib, an oral covalent Janus kinase 3 (JAK3)/TEC inhibitor, is now used for alopecia areata (AA), but pragmatic early-on-treatment markers to guide continuation decisions are needed. We evaluated whether the Week-12 (W12) change in Severity of Alopecia Tool (ΔSALT) predicts Week-24 (W24) response in real-world care.
METHODS: We conducted a single-center observational cohort of consecutive patients with moderate-to-severe AA treated with ritlecitinib 50 mg once daily. Assessments occurred at baseline (V0, n = 77) and W12 (n = 55), W24 (n = 32), W36 (n = 20), W48 (n = 11), W60 (n = 7). The primary endpoint was the proportion achieving SALT ≤ 20 at W24. Secondary endpoints included SALT trajectory, clinician-reported outcomes (ClinRO) for eyebrows/eyelashes, patient-reported outcomes (HADS, Skindex-16), and safety/laboratories. Exploratorily, we tested ΔSALT V0 to W12 as a predictor of W24 response using receiver operating characteristic/area under the curve (ROC/AUC).
RESULTS: Median SALT declined from 90.0 (V0) to 70.0 (W12) and 30.0 (W24); intra-individual median ΔSALT vs. baseline was -10.0 at W12 and -45.0 at W24. Responders (SALT ≤ 20) were 18.2% at W12 (10/55) and 43.8% at W24 (14/32). Periocular ClinRO improved by W24 in 54.5% (eyebrows) and 36.4% (eyelashes). Patient-reported outcomes improved from W12 to W24. Safety was favorable: No serious adverse events or dose modifications were reported; adverse events were mostly mild to moderate (e.g., headache, acne, upper respiratory tract infection [URTI]/nasopharyngitis), and laboratory panels remained stable with modest lipid increases. Early ΔSALT robustly discriminated W24 outcomes: Median -41.0 in future responders vs. +3.0 in non-responders with an AUC = 0.875. ΔSALT at W12 also predicted sustained response at W48 (AUC 0.83). In multivariable analysis, ΔSALT remained independently associated with W24 response (odds ratio [OR] 1.52 per 10-point decrease).
CONCLUSIONS: In routine practice, ritlecitinib produced rapid, clinically meaningful improvement with good tolerability. The on-treatment ΔSALT at 12 weeks is a pragmatic predictor of 24-week success and supports a treat-to-target checkpoint to inform continuation/optimization decisions alongside ClinRO and PROs.
METHODS: We conducted a single-center observational cohort of consecutive patients with moderate-to-severe AA treated with ritlecitinib 50 mg once daily. Assessments occurred at baseline (V0, n = 77) and W12 (n = 55), W24 (n = 32), W36 (n = 20), W48 (n = 11), W60 (n = 7). The primary endpoint was the proportion achieving SALT ≤ 20 at W24. Secondary endpoints included SALT trajectory, clinician-reported outcomes (ClinRO) for eyebrows/eyelashes, patient-reported outcomes (HADS, Skindex-16), and safety/laboratories. Exploratorily, we tested ΔSALT V0 to W12 as a predictor of W24 response using receiver operating characteristic/area under the curve (ROC/AUC).
RESULTS: Median SALT declined from 90.0 (V0) to 70.0 (W12) and 30.0 (W24); intra-individual median ΔSALT vs. baseline was -10.0 at W12 and -45.0 at W24. Responders (SALT ≤ 20) were 18.2% at W12 (10/55) and 43.8% at W24 (14/32). Periocular ClinRO improved by W24 in 54.5% (eyebrows) and 36.4% (eyelashes). Patient-reported outcomes improved from W12 to W24. Safety was favorable: No serious adverse events or dose modifications were reported; adverse events were mostly mild to moderate (e.g., headache, acne, upper respiratory tract infection [URTI]/nasopharyngitis), and laboratory panels remained stable with modest lipid increases. Early ΔSALT robustly discriminated W24 outcomes: Median -41.0 in future responders vs. +3.0 in non-responders with an AUC = 0.875. ΔSALT at W12 also predicted sustained response at W48 (AUC 0.83). In multivariable analysis, ΔSALT remained independently associated with W24 response (odds ratio [OR] 1.52 per 10-point decrease).
CONCLUSIONS: In routine practice, ritlecitinib produced rapid, clinically meaningful improvement with good tolerability. The on-treatment ΔSALT at 12 weeks is a pragmatic predictor of 24-week success and supports a treat-to-target checkpoint to inform continuation/optimization decisions alongside ClinRO and PROs.