Switching between Janus kinase (JAK) inhibitors may offer another treatment approach for patients with severe alopecia areata who experience inadequate or non-durable responses to baricitinib. However, real-world evidence supporting this strategy remains limited.This multicentre retrospective cohort study across Italian referral centres assessed 152 patients switched to ritlecitinib 50 mg once daily after receiving baricitinib for at least 24 weeks. Post-switch outcomes were available for 138 patients.

During baricitinib treatment, only 7.1% (10/141) achieved a SALT50 response, while 3.5% (5/144) had a final SALT score of 20 or lower. During ritlecitinib follow-up, 21.7% (30/138) achieved a SALT score of 20 or lower.Among patients observed at each assessment, median SALT scores decreased from 95 at treatment initiation to 70 at week 24 and 10 at week 52. However, late follow-up data…