Baricitinib Plus Phototherapy Beneficial for Severe Vitiligo

TOPLINE:

Baricitinib, a Janus kinase (JAK) inhibitor, combined with narrowband ultraviolet B (UVB) phototherapy, reduced disease activity and improved repigmentation and quality of life in adults with extensive and active vitiligo, in a phase 2 study.

METHODOLOGY:

• A multicenter, double-blind, proof-of-concept phase 2 randomized clinical trial included 49 adults (71% women; median age, 49.9 years) with extensive, active nonsegmental vitiligo, conducted at four dermatology departments in France between July 2021 and April 2023.
• Participants were randomly assigned 3:1 to receive either baricitinib (4 mg/d) or placebo for 36 weeks. Narrowband UVB, the standard treatment for widespread or active vitiligo, was added after 12 weeks in both groups and continued twice weekly for 24 weeks.
• The primary outcome was the mean percentage change in the total Vitiligo Area Scoring Index (VASI) from baseline at week 36.
• Secondary outcomes were change in total VASI score from baseline to weeks 12 and 24, facial VASI score, Vitiligo Extent Score, Vitiligo European Task Force assessment–extent, and Vitiligo Signs of Activity Score.

TAKEAWAY:

• The baricitinib group achieved a mean 44.8% reduction in total VASI scores at week 36 compared with a 9.2% reduction in the placebo group (P = .02).
• At week 36, 53%, 27%, and 6% of participants in the baricitinib group achieved ≥ 50%, ≥ 75%, and ≥ 90% improvement in total VASI score, respectively, compared with 9%, 0%, and 0% in the placebo group.
• At week 36, facial VASI score improvements of ≥ 75% and ≥ 90% were observed in 56% and 50% of participants in the baricitinib group, respectively, compared with 9% and 9% of those in the placebo group.
• Baricitinib led to greater improvement in the facial VASI score at week 24 and week 36 and in disease activity and quality of life at week 24. No significant difference was observed in the frequency of adverse events between the two groups.

IN PRACTICE:

“This proof-of-concept randomized clinical trial highlighted the efficacy of combining the JAK1/JAK2 inhibitor baricitinib with narrowband UVB in the treatment of adults with active vitiligo,” the authors wrote. The finding “justifies the completion of a larger confirmatory phase 3 trial in the future.”

SOURCE:

The study was led by Julien Seneschal, MD, PhD, Department of Dermatology and Pediatric Dermatology, Hôpital Saint-André, Bordeaux, France. It was published online on January 22 in JAMA Dermatology.

LIMITATIONS:

Study limitations were the small number of participants and inability to assess the impact of JAK inhibitors alone.

DISCLOSURES:

This study was funded by Eli Lilly and Company. Seneschal disclosed receiving grants and personal fees from pharmaceutical companies including Eli Lilly and Company and also held a patent. Two authors received grants, personal fees, and owned patents outside this work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.