- Indication
- Alopecia Areata - Severe
- RAG rating
- Red
- Document type
- Decision document
- Place
- Hertfordshire and West Essex ICB
- Output type
- Pharmacy / Prescribing
Ritlecitinib
Ritlecitinib (Litfulo)
HERTFORDSHIRE AND WEST ESSEX AREA PRESCRIBING COMMITTEE (HWE APC)
Ritlecitinib for treating severe alopecia areata in people 12 years and over
RED
Recommended for restricted prescribing by specialist only.
Not recommended for primary care prescribing.
Name generic (trade) Ritlecitinib (Litfulo)
What it is immunosuppressant, Janus-associated kinase (JAK) inhibitor
Indication Treatment of severe alopecia areata
Date decision last revised March 2024
Decision status Final
NICE Guidance NICE TA958 recommended for restricted use
HWE APC recommendation:
Ritlecitinib is recommended, within its marketing authorisation, as an option for treating severe alopecia areata in people 12 years and over in line with NICE TA958
Ritlecitinib is only recommended if the company provides it according to the commercial arrangement. Ritlecitinib should not be prescribed on FP10 as the commercial discount will not apply. Approval for initial and ongoing treatment is via Blueteq system.
Patients with severe alopecia are defined as having a Severity of Alopecia Tool (SALT) score of 50 or more and where non-pharmacological treatment options (i.e. wigs, psychological support) are inadequate or unacceptable.
Treatment should be initiated by a consultant dermatologist experienced in the diagnosis and treatment of alopecia areata. Prior to commencing ritlecitinib a discussion should be had with the patient that treatment will need to be discontinued if limited hair regrowth is achieved or if there are significant adverse effects. It is likely that any regrown hair will be lost upon discontinuation, and patients should be made aware of this prior to commencing treatment.
The following review intervals are recommended in line with the NICE clinical and cost effectiveness assessment undertaken as part of TA958, local agreement and the summary of product characteristics for Ritlecitinib:
- Application via blueteq from consultant dermatologist experienced in the diagnosis and treatment of alopecia areata.
- Blood monitoring in accordance with the Summary of Product Characteristics - Before treatment initiation, 4 weeks after initiation, and thereafter according to routine patient management.
- Review for response at 24 weeks to 36 weeks after starting treatment: Treatment should be discontinued at this review if patients show a worsening in their condition, i.e. a higher SALT score than at initiation.
- Review for continuation of treatment at 48 weeks after starting treatment: Treatment should be discontinued in patients where an absolute SALT score of ≤20 is not achieved.
- The ongoing therapeutic benefit of ritlecitinib should be reviewed at least annually after week 48 and the benefits and risks of ongoing treatment discussed with the patient. Where initial therapeutic benefit has not been maintained, treatment with ritlecitinib should be discontinued. Blueteq submission by clinical team required annually for continuation of funding.