Advancements in Vitiligo: 2024 and Beyond

Vitiligo has long been a challenging condition to manage effectively. However, recent years have seen significant strides in understanding and treating this condition. In this Topical Conversations segment, Seemal Desai, MD, FAAD, shares his excitement about the evolving landscape of vitiligo treatment.

Innovations in management and treatment of vitiligo

Over the past several years, there have been notable innovations in the management and treatment of vitiligo. One of the most significant milestones was the introduction of the first FDA-approved therapy for repigmenting vitiligo, topical ruxolitinib 1.5% cream. Topical ruxolitinib 1.5% cream is currently the only FDA-approved treatment for nonsegmental vitiligo repigmentation.  

In the TRuE-V1 and TRuE-V2 trials of ruxolitinib cream 1.5%, nearly 1 in 3 patients achieved at least 75% improvement in the Facial Vitiligo Area Scoring Index (F-VASI75) and 24 weeks. Also at 24 weeks, ~15% of patients achieved complete or nearly complete repigmentation in F-VASI (F-VASI90).

Emerging research on oral therapeutics for vitiligo

Looking ahead to 2024 and beyond, Dr Desai anticipates the emergence of new data on oral JAK inhibitors for vitiligo. While topical treatments have shown promise, oral JAK inhibitors present a new frontier in vitiligo treatment. Among these, oral upadacitinib has shown promising results in recent studies. Additionally, research is underway on oral povorcitinib and other oral therapeutics, offering potential benefits beyond repigmentation.

Upadacitinib

At week 24 of a 52-week, Phase 2b multicenter, randomized, double-blind, placebo-controlled study evaluating upadacitinib in adults with nonsegmental vitiligo, upadacitinib met the primary endpoint of percent change from baseline in F-VASI with 11-mg and 22-mg doses versus placebo in adults with nonsegmental vitiligo.

At week 52, the percent reduction from baseline in F-VASI was numerically greater than results at week 24 for all upadacitinib doses.

The safety profile was consistent with the known safety profile for upadacitinib.

Povorcitinib

In a Phase 2b randomized, double-blind, placebo-controlled, dose-ranging clinical trial evaluating the safety and efficacy of povorcitinib, an oral small-molecule JAK1 inhibitor, results showed that treatment for adult patients with extensive nonsegmental vitiligo was associated with substantial total body and facial repigmentation at Week 52.

Povorcitinib was well tolerated at all doses and also shows evidence of potential durability of response following treatment discontinuation, with 32 patients who completed the follow-up period through Week 76 maintaining total body and facial repigmentation.

Future prospects

The landscape of vitiligo treatment is rapidly evolving, with exciting developments on the horizon for 2024 and beyond. From the introduction of FDA-approved topical therapies to the emergence of oral JAK inhibitors for vitiligo, dermatology is witnessing unprecedented progress in the management of this challenging condition.