In a significant advancement for vitiligo treatment, researchers have demonstrated that combining the Janus kinase (JAK) inhibitor baricitinib with narrowband ultraviolet B therapy yields substantial improvements in patients with severe, active nonsegmental vitiligo.
The phase 2 proof-of-concept study, led by Dr. Julien Seneschal from the University of Bordeaux's Department of Dermatology and Pediatric Dermatology, enrolled 49 patients with a median age of 49.9 years, predominantly women (71%). The trial compared 37 patients receiving 4 mg daily baricitinib against 12 patients on placebo, with both groups undergoing narrowband UVB therapy initiated at week 12.
Significant Clinical Improvements
The results were striking, with the baricitinib group showing a mean Vitiligo Area Scoring Index (VASI) score improvement of 44.8% from baseline to week 36 (95% CI, -58.4 to -31.3). In contrast, the placebo group achieved only a 9.2% improvement (95% CI, -27.7 to -24.7). A post-hoc analysis revealed a statistically significant difference between the groups at week 36 (P = .02).
"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," Dr. Seneschal explained. "The study data showed baricitinib combined with phototherapy also provided rapid and clinically meaningful repigmentation."
Treatment Response Rates
The combination therapy demonstrated robust efficacy across various response thresholds:
- VASI 50: 18 patients in the baricitinib group vs. 1 in placebo
- VASI 75: 9 patients in the baricitinib group vs. 0 in placebo
- VASI 90: 2 patients in the baricitinib group vs. 0 in placebo
Safety and Quality of Life
While the treatment showed promising results, safety monitoring revealed adverse events in 24 baricitinib-treated patients and 7 placebo patients. Three serious adverse events were reported: a viral infection in the placebo group and back pain and pulmonary embolism in the baricitinib group. However, the difference in adverse event rates between groups was not statistically significant.
Notably, patients receiving baricitinib reported significantly improved quality of life by week 24 compared to those on placebo.
Clinical Implications
Dr. Seneschal emphasized the importance of the combination approach: "Phototherapy alone, a standard treatment for vitiligo, was not sufficient to induce a significant level of repigmentation in patients with extensive and active disease. The combination of baricitinib and UV light therapy was the key factor that induced meaningful changes for patients."
These findings suggest a promising new treatment pathway for patients with severe vitiligo, particularly those who may not respond adequately to phototherapy alone. The study underscores the potential of targeted immunotherapy combined with established treatments in managing this challenging autoimmune condition.
