Two JAK inhibitors for non-segmental vitiligo showed better skin clearance in phase 2b trial extensions — ritlecitinib plus twice-weekly doses of UVB light and upadacitinib.
San Diego — In two different phase 2b trial extensions, oral treatment with Janus kinase inhibitors showed improved skin clearance, according to presentations at a late-breaking session at the annual meeting of the American Academy of Dermatology .
Important to interpretation of results, there was an additional twist. Patients in the randomized arm who had < 10% improvement in the total vitiligo area severity index at week 12 of the extension were discontinued from the study. At the end of 24 weeks, both groups had a substantial response to their assigned therapy, but the addition of NB-UVB increased rates of response, although not always at a level of statistical significance, according to Guttman-Yassky.
She acknowledged that the design of this analysis was "complicated" and that the number of randomized patients was small. She suggested the findings support the potential for benefit from the combination of a JAK inhibitor and NB-UVB, both of which have shown efficacy as monotherapy in previous studies. She indicated that a trial of this combination is reasonable while awaiting a more definitive study.
The 24-week dose-ranging data from the upadacitinib trial were previously reported at the 2023 annual meeting of the European Association of Dermatology and Venereology. In the placebo-controlled portion, which randomized 185 patients with extensive non-segmental vitiligo to 6 mg, 11 mg, or 22 mg, the two higher doses were significantly more effective than placebo.
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