Oral upadacitinib shows promise for restoring skin colour in non-segmental vitiligo
核心洞察
The Viti-Up clinical trials, published in The Lancet, evaluated oral upadacitinib in 614 people aged 12 and older with non-segmental vitiligo (搜索) across 90 sites worldwide.
After 48 weeks, upadacitinib produced significantly greater skin repigmentation than placebo, with 19.4% and 21.5% of treated patients achieving at least 50% body improvement versus 5.9% on placebo.
Facial repigmentation was also notable, with roughly 25.2% and 23.4% of patients achieving at least 75% improvement in facial skin colour compared with 5.9% and 6.9% on placebo.
An oral medicine called upadacitinib can help restore skin colour in some people with vitiligo (搜索), according to findings from the Viti-Up clinical trials published in The Lancet. The studies examined whether upadacitinib could benefit people with non-segmental vitiligo (搜索), the most common form of the condition, and involved 614 participants aged 12 and older across 90 sites worldwide.
Participants received either 15 milligrams of upadacitinib once daily or a placebo for 48 weeks. Vitiligo (搜索) is a long-term autoimmune condition in which the body's immune system mistakenly attacks melanocytes, the cells that produce melanin, the pigment responsible for skin colour. When these cells are damaged or destroyed, white patches can appear on the skin.
The condition can affect anyone regardless of skin colour, though patches may be more noticeable on darker skin, potentially increasing the risk of stigma and discrimination. Some people with vitiligo (搜索) also face false beliefs that the condition is contagious. While sometimes treated as only a cosmetic problem, vitiligo can have a much stronger effect on people's lives, with some individuals experiencing low self-esteem, anxiety, depression, social isolation, and problems in relationships or at work.
Mechanism of Action
The new treatment works by reducing some of the immune system activity believed to damage the cells responsible for skin colour. This means it targets what is happening inside the body rather than only treating the appearance of the skin. "Targeting the underlying inflammation may offer a systemic treatment option which could help patients achieve visible results," researchers said.
Efficacy Results
After 48 weeks, more people who took upadacitinib experienced a significant return of skin colour compared with those who received the placebo. In one trial, 19.4 per cent of people taking the medicine had at least a 50 per cent improvement in the amount of vitiligo (搜索) covering their body, compared with 5.9 per cent among those who received the placebo. In the second trial, the figures were 21.5 per cent and 5.9 per cent, respectively.
The medicine also showed promising results on the face. About 25.2 per cent of patients in one trial and 23.4 per cent in the other achieved at least 75 per cent improvement in facial skin colour, compared with 5.9 per cent and 6.9 per cent among people who received the placebo.
Researchers also found that skin colour continued to improve during the 48 weeks of treatment, suggesting that some patients may see further improvement with longer treatment, although more research is needed to confirm this.
Clinical Significance and Regulatory Status
The findings could be important because people with widespread vitiligo (搜索) have had limited treatment options. In some regions, upadacitinib could become one of the first medicines taken by mouth specifically approved for non-segmental vitiligo (搜索). European regulators gave a positive recommendation for its use in adults and adolescents in June 2026, although approval and availability may differ from one country to another.
"Vitiligo (搜索) is an autoimmune skin disease with high stigma and significant burden to patients with limited treatment options available," researchers noted.
Limitations and Safety Considerations
The medicine is not a cure for vitiligo (搜索) and may not work for everyone. Most people who took part in the trials did not reach the main level of skin colour improvement set by researchers, meaning more treatments are still needed and scientists need to understand why some people respond better than others.
Safety is also an important concern. During the 48-week studies, some of the side effects reported included upper respiratory infections, acne and nasopharyngitis, which is inflammation of the nose and throat. Researchers did not identify any new safety concerns during the trials. However, because upadacitinib changes the way the immune system works, its long-term safety will need to be closely monitored, particularly if people need to take it for many years.
Participants in the research will continue to be followed for a longer period, with the extended study allowing researchers to monitor some patients for up to 160 weeks in total.
Remaining Questions
Another concern is whether the clinical trials included enough people from different racial and ethnic backgrounds. This is important because vitiligo (搜索) affects people around the world, and the social and emotional effects of the condition can differ between communities. Cost and availability could also determine who benefits from the new treatment, as a medicine may work well in clinical trials but have little impact if patients cannot afford it or if it is not available in countries with limited healthcare resources.
The development of upadacitinib represents a change in the way scientists understand and treat vitiligo (搜索). Instead of viewing the condition simply as a change in appearance, researchers are increasingly focusing on the body's immune system and the processes that cause the loss of skin colour. Researchers say more studies are needed to determine how long the results last, whether the medicine can be used safely for many years, which patients are most likely to benefit, and whether restoring skin colour also improves people's emotional wellbeing and quality of life.