Baricitinib and ritlecitinib in alopecia areata: a nationwide prospective real-world registry study

Background JAK inhibitors baricitinib and ritlecitinib are approved for treatment of severe alopecia areata (AA). However, prospective real-world data on effectiveness, disease burden and tolerability are limited. Objective To evaluate the real-world effectiveness and tolerability of baricitinib and ritlecitinib in adults with AA. Methods In this nationwide, prospective, multicenter registry (STA 2 R), adults initiating baricitinib or ritlecitinib between January 2024 and April 2026 were included. The primary outcome was SALT score trajectory over 12 months, analyzed using a linear mixed model adjusted for baseline SALT score, AA subtype, age, sex, atopic history, disease duration, prior treatment response, and prior JAK inhibitor use. Results A total of 166 patients were included (baricitinib n=106, ritlecitinib n=60). SALT scores declined significantly over time in both groups (β=−4.22 points/month), with no significant difference between treatments. At 12 months, adjusted SALT scores were 33.7 for baricitinib and 33.4 for ritlecitinib, with SALT ≤20 achieved by 30/47(64%) and 12/24(50%) of patients, respectively. Both treatments were associated with improvements in disease burden and were well tolerated.