Samantha K. Kurosky

Background: Ritlecitinib, a JAK3/TEC family kinase inhibitor, and baricitinib, a JAK1/2 inhibitor, are approved for treating severe alopecia areata (AA). Objective: Develop a cost-per-responder analysis for ritlecitinib and baricitinib for treating severe AA to estimate the budget impact based on clinical efficacy, available dosages, and pricing structure. Methods: A decision tree evaluated cost implications of once-daily ritlecitinib 50 mg, or baricitinib 2 mg and 4 mg treatment over 1 year from a US perspective. Drug costs were estimated using wholesale acquisition costs. Distribution across treatment and dosing options were based on real-world evidence. We defined shorter-term response as Severity of Alopecia Tool (SALT) score relative change from baseline ≥30% (SALT Δ≥30%; SALT ₃₀ ) at Weeks 18 and 24, and longer-term response as absolute SALT score ≤20 at Weeks 36 and 52. Patients initiating baricitinib 2 mg with no shorter-term response could uptitrate to 4 mg or discontinue therapy. Decision probabilities were derived from real-world evidence and clinical trial data. Results: At Week 24, 52.10% of ritlecitinib initiators and 36.28% of baricitinib initiators achieved SALT Δ ≥30%; at Week 52, 40.26% and 30.63% of ritlecitinib and baricitinib initiators, respectively, achieved SALT ≤20. Baricitinib had a higher cost per responder than ritlecitinib at Weeks 24 ($54 887 vs $45 577) and 52 ($107 217 vs $94 834). Cost-equivalence was reached at Week 52 ($38 180), with 42.72% of baricitinib patients initiating 2 mg treatment. Sensitivity analyses showed ritlecitinib cost per responder was lower at Week 24 (difference, −$1532) and higher at Week 52 (difference, $10 728) than only baricitinib 2 mg use, and lower at Weeks 24 and 52 (difference, −$20 001 and −$60 073) than only baricitinib 4 mg use. The lower cost per responder for ritlecitinib 50 mg vs baricitinib 2 or 4 mg at Weeks 24 and 52, and greater early efficacy and fewer discontinuations is consistent with the results of a prior indirect treatment comparison that supported favorable outcomes with ritlecitinib 50 mg vs baricitinib 2 mg. Conclusions: Ritlecitinib 50 mg demonstrated a lower cost per responder than baricitinib 2 or 4 mg at Weeks 24 and 52, which may inform reimbursement or formulary inclusion of ritlecitinib for treating AA.

Introduction Ritlecitinib, an oral, selective dual inhibitor of Janus kinase (JAK) 3 and tyrosine kinase expressed in hepatocellular carcinoma (TEC) family kinases, is approved for treating severe alopecia areata (AA) in patients aged ≥ 12 years in the USA. This study describes characteristics, treatment satisfaction, and success among adults initiating ritlecitinib. Methods A sample of US dermatologists treating adults who received ritlecitinib for severe AA were surveyed between November 2023 and June 2024. Demographics, clinical characteristics, treatment history, satisfaction, and health-related quality of life were analyzed overall, among recent initiators, and stratified by treatment duration. Results A total of 123 adults were included (mean age 37.1 years; 57% male; 79% white; 88% commercial insurance). Mean disease duration was 2.1 years. At ritlecitinib initiation (n = 93), mean scalp hair loss was 71% and 73% had worsening AA. The proportion of patients with hair regrowth increased with longer treatment duration, 49% among those with < 3 months of treatment (n = 18/37) to 82% with > 6 months (n = 28/34). Physicians reported many recent initiators (n = 26) felt moderate/severe embarrassment (84%), frustration (73%), and anxiety (65%) due to their AA. Among patients with available data (n = 102), ritlecitinib was the first AA treatment for 46%. Treatment goals (n = 123) included reducing hair loss (94%), improving quality-of-life (41%), and achieving long-term control (32%). Reasons for selecting ritlecitinib (n = 113) included its ability to reduce scalp hair loss (38%), cost–benefit ratio (28%), and safety profile (25%). Satisfaction with AA control was 54%, 68%, and 85% after < 3 (n = 20/37), 3–6 (n = 27/40), and > 6 months (n = 29/34), respectively, of ritlecitinib treatment. Conclusions Many patients experienced psychological burden due to their AA around the start of treatment. Ritlecitinib was chosen for its efficacy, safety, and cost-effectiveness. Hair regrowth, disease stability, and treatment satisfaction increased with longer ritlecitinib treatment duration suggesting sustained treatment is important for achieving treatment goals.

Vitiligo is a chronic depigmenting autoimmune skin disease that may be associated with a significant quality-of-life burden and psychosocial comorbidities. Reliable and comparable prevalence rates are critical in building an evidentiary foundation for understanding the full landscape of vitiligo disparities. This study aimed to assess the prevalence of vitiligo among adults in the USA and in five European countries (5EU; France, Germany, Italy, Spain, and the UK). This study used data from the 2024 US and 5EU National Health and Wellness Survey (NHWS), a population based, self-reported, syndicated cross-sectional survey of adults (age ≥ 18 years). Respondents were recruited from large internet panels and completed the survey online. Results were weighted to reflect demographic distributions of the general adult population in each country. Self-reported prevalences of ever experiencing vitiligo or having vitiligo diagnosed by a clinician and proportions of patients having had a healthcare provider visit in the last 6 months were reported. Data from 75,013 participants in the USA and 62,022 in Europe were included. The prevalence of adults self-reporting that they ever experienced vitiligo was 2.3% in the USA and 2.0% in Europe (France, 1.7%; Germany, 2.0%; Italy, 2.3%; Spain, 2.2%; UK, 2.1%). The prevalence of adults self-reporting a clinical diagnosis of vitiligo was 0.77% in the USA and 0.76% in Europe (France, 0.73%; Germany, 0.73%; Italy, 0.85%; Spain, 0.89%; UK, 0.65%). The proportion of adults with clinically diagnosed vitiligo who self-reported a dermatologist visit in the past 6 months was 30.7% in the USA and 22.8% in Europe. This study of adults in the USA and Europe, which used self-reported data collected from the 2024 NHWS, found that the prevalence of self-reported vitiligo was 1.7-2.3%, and the prevalence of self-reported clinically diagnosed vitiligo was 0.65-0.89%.

Introduction Alopecia areata (AA) is an autoimmune disease characterized by nonscarring hair loss that may impact quality of life (QoL). After 2021, new therapies were approved to treat severe AA in Taiwan; however, there is no global definition of severe AA. Dermatologists may use other criteria in addition to scalp hair loss (SHL) when estimating severity. This study evaluates the impact of AA on patient QoL and how dermatologists assessed disease severity and managed AA in Taiwan prior to availability of new therapies. Methods Dermatologists completed the Adelphi Real World AA Disease Specific Programme™ cross-sectional survey. Each provided their perspective on assessing AA severity and available AA treatments, and information on patients consulting with AA. Results were analyzed descriptively and stratified by dermatologist-assessed AA severity. Results Fifty dermatologists reported median (interquartile range) SHL of 45% (31–51%) and 76% (51–90%) as typical of “severe” and “very severe” AA, respectively, based on 285 patients. Multiple factors were considered, including SHL, disease duration, and prior treatment responses. Mean (SD) time on current therapy was 8.3 (13.0) months. Patients with severe/very severe disease received varied first- and second-line treatments and had more severe QoL impacts, including anxiety/worry, depression, and impairments in daily life and activities. Most dermatologists felt confident in diagnosing AA; however, few were satisfied with treatment options for patients with severe AA. Conclusions Dermatologists in Taiwan did not define AA disease severity solely based on extent of SHL, and many felt there was an unmet need for effective treatments for severe disease.

Vitiligo is an autoimmune disease resulting in skin depigmentation and individuals report substantial psychosocial burden. However, vitiligo-related quality of life impacts appear heterogeneous and may be influenced by social determinants of health. This cross-sectional survey aimed to describe characteristics and vitiligo-related quality of life impacts among adults in Brazil, China, India, and South Africa. Results were stratified by country and examined by bivariate analysis. Respondents (n = 2202) were mean (standard deviation) 36.9 (11.5) years of age. The most frequently reported income quartile was the highest quartile in China, India, and South Africa, and second-lowest quartile in Brazil. Mean time since initial diagnosis was 11.7 years. Mean % body surface area with depigmentation ranged from 3.7% (China) to 9.7% (South Africa). Mean Dermatology Life Quality Index scores ranged from 5.8 in Brazil to 10.3 in India, indicating a 'moderate' effect of vitiligo on quality-of-life; for 32.3% of respondents, vitiligo had a 'very-to-extremely large' impact on quality-of-life. Mean daily activity impairment was 28.9%. Employed participants reported mean work impairment of 35.6%. Adults with vitiligo in Brazil, China, India, and South Africa reported diverse demographic, socioeconomic, and clinical characteristics. Overall, vitiligo had a moderate impact on quality of life and was associated with reduced work productivity and activity impairments.