EADV 2025: Alopecia areata highlights

EADV 2025: Advances in treating alopecia areata

Updates from the European Academy of Dermatology and Venereology (EADV) 2025 Congress highlighted significant progress in the treatment and monitoring of alopecia areata (AA), including:

• Sonographic biomarkers to predict JAK inhibitor response
• Long-term ritlecitinib data from the ALLEGRO program
• Early real-world evidence for ritlecitinib in severe AA

Ultra-high frequency ultrasound: Predicting AA response to baricitinib

Flavia Manzo Margiotta (University of Pisa, Italy) presented a prospective study evaluating ultra-high frequency ultrasound (UHFUS) as a non-invasive method to monitor AA and predict response to baricitinib.

Deep hair follicles may help predict treatment success

The prospective study comprised 29 adults with severe AA (SALT ≥50) treated over 24 weeks with baricitinib. UHFUS assessment was conducted before and during the treatment period and focused on the frontal, vertex, occipital, and parietal scalp regions.

This revealed significantly higher deep hair follicles – defined as follicles reaching the reticular dermis – in the frontal (P=0.002), vertex (P=<0.001), left parietal (P=0.003), and occipital (P=0.047) regions in responders to baricitinib versus nonresponders.

Other key metrics, such as sebaceous gland dimensions and ColorDoppler signals, did not significantly predict treatment response.

Manzo stated that the data support UHFUS as a useful tool for personalized AA management, with sonographic biomarkers allowing physicians to better predict treatment success and tailor therapies. She also stressed a need for further research to validate these initial findings.

ALLEGRO: Long-term efficacy of ritlecitinib

Brett King (Dermatology Physicians of Connecticut, Fairfield, USA) shared long-term data from the ALLEGRO and ALLEGRO-LT open-label extension trials evaluating ritlecitinib 50 mg daily in patients aged ≥12 with AA and ≥50% scalp hair loss.

Nearly one-third of patients achieved complete scalp hair regrowth with ritlecitinib over 3 years, with most maintaining their response

At month 36–38, 65.1% of 109 patients with an observable outcome had SALT scores ≤20, and the imputed rate based on the last observation carried forward (LOCF) for the full cohort of 191 patients was 47.1%. SALT ≤10 rates were 52.3% for the observed and 36.7% for the LOCF cohort.

Among those who achieved SALT ≤20 at month 12, 88.3% in the observed and 89.6% in the LOCF cohort maintained their response. Complete scalp regrowth (SALT 0) occurred in 31.2% of observed and 22.5% of the LOCF cohort.

Complete responders (SALT 0 at ≥1 time point) comprised 29.8% of the cohort. Of the complete responders, 61.4% had no further increase in SALT score and 84.2% remained at SALT ≤5.

In addition, 63.2% of observed patients experienced ≥2-grade improvements to eyebrows and 60.4% experienced ≥2-grade improvements to eyelashes.

King concluded that the results support the long-term efficacy of ritlecitinib in AA.

Early real-world evidence: Ritlecitinib for severe AA

A small study presented by Tang Shim (University Hospitals Coventry and Warwickshire NHS Trust, UK) provides early real-world data on ritlecitinib, a selective oral JAK3 and TEC kinase inhibitor.

In the retrospective study, seven patients aged between 16 and 61 with disease durations of 4–7 years and baseline Severity of Alopecia Tool (SALT) scores of 72–100 were treated with ritlecitinib (50 mg daily).

After 12 weeks, SALT scores ranged from 4.1 to 85.9, which Shim said was indicative of a variable but promising improvement.

Adverse events were reported in 57.1% of patients, including one pharyngeal abscess requiring hospitalization and one upper respiratory tract infection. Other side effects, including mouth ulcers and vertigo, were of uncertain relevance. No serious safety concerns or treatment withdrawals occurred.

Shim concluded by reiterating the potential of ritlecitinib as a treatment option for severe AA, while also calling for larger, multicenter studies.

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