Ruxolitinib cream use increases repigmentation rates in vitiligo

Once-daily use of ruxolitinib cream may have a greater rate of repigmentation in patients with vitiligo, according to findings presented at the American Academy of Dermatology virtual meeting.

Pearl Grimes, MD, and colleagues examined repigmentation of affected body parts in adult patients with vitiligo who were treated with ruxolitinib cream.

“Vitiligo lesion location affects repigmentation likelihood, with hands and feet particularly resistant to pigmentation,” Grimes, the director of the Vitiligo & Pigmentation Institute of Southern California, and colleagues wrote. “Meta-analyses of phototherapy and topical calcineurin inhibitors for vitiligo demonstrated no evidence of marked (75% repigmentation) treatment response of hands and feet.”

The researchers analyzed data from a year-long randomized, double-masked phase 2 study of adults between the ages of 18 and 75 years diagnosed with vitiligo with a depigmentation of 0.5% or greater of body surface area (BSA) of the face and 3% or more BSA on nonfacial areas. The patients were randomly assigned into groups that received ruxolitinib cream 1.5% twice daily, ruxolitinib cream 1.5% once daily, ruxolitinib cream 0.5% once daily, ruxolitinib cream 0.15% once daily or vehicle twice daily.

After 24 weeks, patients who received vehicle or ruxolitinib cream 0.15% once daily and did not achieve a facial Vitiligo Area Scoring Index (F-VASI) improvement of 25% or greater were either randomly assigned into one of the higher-dose ruxolitinib groups or continued with their regular dose through 52 weeks. Patients who were randomly assigned again were not included in the analysis.

Of 157 patients (mean age, 48.3 years; 46.5% men; 84.1% white), all depigmented skin, with a baseline total BSA of 20% or less, was treated in 100 patients who were included in the analysis. Overall, patients with a total VASI of 50% (T-VASI50) or greater and 75% or greater (T-VASI75) at the 52-week mark reached the milestone in a dose-dependent manner.

The twice-daily ruxolitinib cream 1.5% regimen led to greater T-VASI50 and T-VASI75 response across all body regions (45% and 15%, respectively).

At week 52, in patients in the once-daily 1.5% group, T-VASI50 responses in hands and feet were 21.1% and 26.3% compared with the 15% and 29.4%, respectively, in the twice daily 1.5% group. T-VASI75 responses were 21.1% in both hands and feet in the once-daily 1.5% group compared with 5% and 17.6%, respectively, in the twice-daily 1.5% group.

“Ruxolitinib cream produced clinically meaningful repigmentation of all body areas in patients with vitiligo,” Grimes and colleagues wrote.