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Researchers encourage use of topical calcineurin inhibitors for vitiligo

Topical calcineurin inhibitors may produce a favorable response in patients with vitiligo, with monotherapy appearing to be effective in children and in those with lesions on the face and neck.

“Our findings are consistent with recent reports on Janus kinase inhibitors showing the improved treatment response with the concomitant use of [narrowband UV-B], and reaffirm the synergistic role of phototherapy and [topical calcineurin inhibitor] treatment,” Ji Hae Lee, MD, PhD, from the department of dermatology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, and colleagues wrote.

Researchers conducted a search of Medline, Embase, Web of Science and Cochrane Library databases and identified 11 studies on the topical calcineurin inhibitor (TCI) mechanism, 36 on TCI monotherapy, 12 on TCI plus phototherapy and one on TCI maintenance therapy.

Mechanism of action, treatment responses, the use of TCIs for maintenance therapy and safety were the focus of the systematic review. Degrees of repigmentation were rated as at least mild (25% repigmentation), at least moderate (50% repigmentation) and marked (75% repigmentation).

Forty-six studies were chosen to evaluate treatment response to TCI therapy; 1,499 patients were included, 941 in the TCI monotherapy group and 558 in the TCI plus phototherapy group.

In TCI monotherapy, a mild response was achieved in 55% of 560 patients in 21 studies (95% CI, 42.2%-67.8%), a moderate response was achieved in 38.5% of 619 patients in 23 studies (95% CI, 28.2%-48.8%) and a marked response was achieved in 18.1% of 520 patients in 19 studies (95% CI, 13.2%-23.1%).

For TCI monotherapy treatment response in children, the researchers reported a mild response in 66.4% of 162 patients in five studies (95% CI, 43.2%-89.7%) and a marked response in 31.7% of patients in five studies (95% CI, 6.7%-56.8%).

Lesions on the face and neck showed the most improvement, with a mild response in 73.1% of 312 patients in 14 studies and a marked response in 35.4% of 353 patients in 16 studies. Lesions on the trunk and extremities had a mild response in 34.2% of 153 patients in seven studies and a marked response in 2.3% of 185 patients in eight studies. Lesions on the hands and feet showed a mild response in 15.1% of 48 patients in three studies, whereas no marked response was observed in 52 patients in four studies.

In TCI plus phototherapy, a mild response was achieved in 89.5% of 433 patients in eight studies (95% CI, 81.1%-97.9%), a moderate response was achieved in 72.9% of 486 patients in 10 studies (95% CI, 57.6%-88.2%) and a marked response was achieved in 47.5% of 490 patients in nine studies (95% CI, 3.06%-64.4%).

In face and neck lesions treated with TCI plus phototherapy, a mild response was achieved in 93.7% of 103 patients in four studies and a marked response was achieved in 55.2% of 103 patients in four studies. In lesions on the trunk and extremities, 85.3% of 161 patients in three studies achieved a mild response and 16.1% of 161 patients in three studies achieved a marked response. Hand and foot lesions were not analyzed because the response rate was minimal in two studies in this group.

The most common adverse events reported were a burning sensation, pruritus and erythema, but they did not require additional treatment.

TCI treatment should be encouraged in patients with vitiligo who are undergoing phototherapy, as the two therapies have synergistic effects, according to the researchers. Moreover, the use of TCIs to maintain remission may be promising, considering the high recurrence rate of vitiligo, they wrote. – by Abigail Sutton

Disclosures: The authors report no relevant financial disclosures.