Baricitinib, narrowband UVB combination therapy improves vitiligo

Key takeaways:

• Within the baricitinib group, patients experienced a mean Vitiligo Area Scoring Index score change of 44.8% from baseline to week 36.
• In contrast, the placebo group saw a 9.2% change.

The Janus kinase inhibitor baricitinib, in combination with narrowband ultraviolet B therapy, improved vitiligo, according to a study.

The study stated that the use of phototherapy alongside [Janus kinase (JAK)] inhibitors has been associated with an increased treatment response among vitiligo patients. However, the efficacy of JAK inhibitors has not been fully evaluated in concomitant with phototherapy.

In a phase 2 trial, proof-of-concept study conducted by Julien Seneschal, MD, PhD, professor in the department of dermatology and pediatric dermatology at the University of Bordeaux, and colleagues found that baricitinib, a JAK inhibitor, improves phototherapy treatment for adults with severe, active and nonsegmental vitiligo.

“Baricitinib alone, after 3 months of treatment, demonstrated the ability to reduce the disease activity score compared to placebo, suggesting that baricitinib effectively halted disease progression,” Seneschal told Healio. “The study data showed baricitinib … combined with phototherapy also provided rapid and clinically meaningful repigmentation in adults with severe, active, nonsegmental vitiligo.”

In the trial, 49 patients (median age, 49.9 years; 71% women) were randomly assigned to receive baricitinib (n = 37) or placebo (n = 12) with narrowband UVB therapy. Each patient received 4 mg baricitinib or placebo per day for 36 weeks, with narrowband UVB therapy introduced at week 12.

Within the baricitinib group, patients experienced a mean Vitiligo Area Scoring Index (VASI) score change of −44.8% (95% CI, −58.4 to −31.3) from baseline to week 36. In contrast, the placebo group saw a −9.2% (95% CI, −27.7 to −24.7) change.

According to the study, the repigmentation seen in the baricitinib group was not significantly greater than the sufficient repigmented surface threshold of 42.9% previously observed in patients treated with narrowband UVB alone; however, a post-hoc analysis revealed a significant difference in VASI score at week 36 between the baricitinib and placebo groups (P = .02).

By week 36, VASI 50, 75 and 90 were achieved by 18, nine and two patients in the combination-treated group, respectively, vs. one achieving VASI 50 and none achieving VASI 75 or 90 in the placebo group. According to the study, baricitinib-treated patients also reported high rates of improved quality of life by week 24 compared with placebo-treated patients.

Twenty-four patients in the baricitinib group and seven in the placebo group experienced adverse events, including three deemed serious — a viral infection in the placebo group and back pain and a pulmonary embolism in the baricitinib group. The difference in adverse events rates was not significant between the groups.

“Phototherapy alone, a standard treatment for vitiligo, was not sufficient to induce a significant level of repigmentation in patients with extensive and active disease,” Seneschal told Healio. “The combination of baricitinib and UV light therapy was the key factor that induced meaningful changes for patients.”