Efficacy and safety of upadacitinib in the treatment of recalcitrant vitiligo

Lubna Khondker; M. Alauddin Khan; Noshin Nabila; Pranam Swapan Dash; Tanjina Nasrin; M. Kamrul Hasan; Pankaj Kanti Nath

doi:10.18203/2320-6012.ijrms20253930

Authors

Lubna Khondker Department of Dermatology and Venereology, Bangladesh Medical University (BMU), Dhaka, Bangladesh
M. Alauddin Khan Department of Dermatology and Venereology, Bangladesh Medical University (BMU), Dhaka, Bangladesh
Noshin Nabila Department of Psychology, Simon Fraser University, Vancouver, Canada
Pranam Swapan Dash Department of Dermatology and Venereology, Bangladesh Medical University (BMU), Dhaka, Bangladesh
Tanjina Nasrin Department of Dermatology and Venereology, Dhaka Medical College Hospital, Dhaka, Bangladesh
M. Kamrul Hasan Department of Dermatology and Venereology, Bangladesh Medical University (BMU), Dhaka, Bangladesh
Pankaj Kanti Nath Department of Dermatology and Venereology, Bangladesh Medical University (BMU), Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2320-6012.ijrms20253930

Keywords:

Atopic dermatitis, Alopecia areata, JAK1 inhibitor, Janus kinase inhibitors, Upadacitinib, Vitiligo

Abstract

Background: Vitiligo is an acquired autoimmune disease resulting in depigmented patches of the skin, often leading to a significant psychosocial burden on patients. Building on recent advancements in understanding the immunological mechanisms in vitiligo pathogenesis, various potential treatment options such as JAK inhibitors are being clinically researched for vitiligo. In this study, upadacitinib was evaluated for its effectiveness and safety in treating recalcitrant vitiligo patients.

Methods: This study was a prospective randomized clinical trial, thirty patients of group A were treated with Upadacitinib, a dose of 15 mg once daily for 16 weeks. Thirty patients of group B were treated with low dose oral prednisolone (0.3 mg/kg body weight) daily for 16 weeks and the severity of vitiligo was measured using the Vitiligo Area Severity Index (VASI).

Results: The study shows that in Group A, the mean reduction of VASI score was lower in segmental vitiligo (1.24±0.43) and higher in acrofacial vitiligo (4.21±1.30). On the other hand, in Group B, the mean reduction of VASI score was almost similar in acrofacial vitiligo (2.17±0.35) and generalized vitiligo (2.23±0.44). The association between type of vitiligo and change in VASI score in Group A was statistically significant (0.002). At month 4, the VASI score was lower in group A (5.70±3.61) compared to group B (8.61±3.43), which was statistically significant (p=0.006).

Conclusions: The observed repigmentation with minor adverse effects in all vitiligo patients with upadacitinib suggests that upadacitinib could be a promising therapeutic option for this challenging condition.

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References

Bergqvist C, Ezzedine K. Vitiligo: a review. Dermatology. 2020;236(6):571–92. DOI: https://doi.org/10.1159/000506103

Ezzedine K, Eleftheriadou V, Jones H. Psychosocial effects of vitiligo: a systematic literature review. Am J Clin Dermatol. 2021;22:757-74. DOI: https://doi.org/10.1007/s40257-021-00631-6

Silveira LP, Grijsen, ML, Follador I. How persistent stigma and discrimination keep people with visible skin diseases out of jobs: vitiligo in Brazil today. Lancet Reg Health Am. 2023;23:100524. DOI: https://doi.org/10.1016/j.lana.2023.100524

Bibeau K, Ezzedine K. Harris JE. Mental health and psychosocial quality-of-life burden among patients with vitiligo: findings from the global VALIANT study. JAMA Dermatol. 2023;159:1124-8. DOI: https://doi.org/10.1001/jamadermatol.2023.2787

Bergqvist C, Ezzedine K. Vitiligo: a focus on pathogenesis and its therapeutic implications. J Dermatol. 2021;48(3):252–70. DOI: https://doi.org/10.1111/1346-8138.15743

Narayan VS, Uitentuis SE, Luiten RM. Patients' perspective on current treatments and demand for novel treatments in vitiligo. J Eur Acad Dermatol Venereol. 2021;35:744-8. DOI: https://doi.org/10.1111/jdv.16927

Qi F, Liu F, Gao L. Janus kinase inhibitors in the treatment of vitiligo: a review. Front Immunol. 2021;12:790125. DOI: https://doi.org/10.3389/fimmu.2021.790125

Frisoli ML, Essien K, Harris JE. Vitiligo: Mechanisms of Pathogenesis and treatment. Annu Rev Immunol. 2020;38:621–48. DOI: https://doi.org/10.1146/annurev-immunol-100919-023531

Seong SH, Oh SH. Up-and-Coming Drugs for the Treatment of Vitiligo. Ann Dermatol. 2024;36(4):197–208. DOI: https://doi.org/10.5021/ad.24.038

Parmentier JM, Voss J, Graff, C. In vitro and in vivo characterization of the JAK1 selectivity of upadacitinib (ABT-494). BMC Rheumatol. 2018;2:23. DOI: https://doi.org/10.1186/s41927-018-0031-x

Picardo M, Huggins RH, Jones H. The humanistic burden of vitiligo: a systematic literature review of quality-of-life outcomes. J Eur Acad Dermatol Venereol. 2022;36:1507-23. DOI: https://doi.org/10.1111/jdv.18129

Acharya P, Mathur M. Association of atopic dermatitis with vitiligo: a systematic review and meta-analysis. J Cosmet Dermatol. 2020;19(8):2016–20. DOI: https://doi.org/10.1111/jocd.13263

Ravaioli GM, Patrizi A, Neri I. Vitiligo and atopic dermatitis in young girls: may Koebner phenomenon play a role. An Bras Dermatol. 2023;98(1):125–7 DOI: https://doi.org/10.1016/j.abd.2021.02.014

Utama A, Wijesinghe R, Thng S. Janus kinase inhibitors and the changing landscape of vitiligo management: a scoping review. Int J Dermatol. 2024;63(8):1020–35. DOI: https://doi.org/10.1111/ijd.17157

Su X, Luo R, Ruan S, Zhong Q, Zhuang Z, Xiao Z, et al. Efficacy and tolerability of oral upadacitinib monotherapy in patients with recalcitrant vitiligo. J Am Acad Dermatol. 2023;89(6):1257–9. DOI: https://doi.org/10.1016/j.jaad.2023.07.1016

Zhu Y, Shi Z, Xu Z, Liu S, Zhang J, Wang Q, et al. Oral tofacitinib, baricitinib and upadacitinib monotherapy for steroid-resistant vitiligo: a prospective case series. J Eur Acad Dermatol Venereol. 2025;39(2):128–30. DOI: https://doi.org/10.1111/jdv.20109

Guttman-Yassky E, Teixeira HD, Simpson EL. Once-daily upadacitinib versus placebo in adolescents and adults with moderate-to-severe atopic dermatitis (Measure Up 1 and Measure Up 2): results from two replicate double-blind, randomised controlled Phase 3 trials. Lancet. 2021;397(10290):2151–68. DOI: https://doi.org/10.1016/S0140-6736(21)00588-2

Cunningham KN, Rosmarin D. Vitiligo treatments: review of current therapeutic modalities and JAK inhibitors. Am J Clin Dermatol. 2023;24(2):165–86. DOI: https://doi.org/10.1007/s40257-022-00752-6

Flora A, Kozera E, Frew JW. Treatment of alopecia areata with the janus kinase inhibitor upadacitinib: a retrospective cohort study. J Am Acad Dermatol. 2023;89(1):137–8. DOI: https://doi.org/10.1016/j.jaad.2022.12.056

Gori N, Cappilli S, Di Stefani A. Assessment of alopecia areata universalis successfully treated with upadacitinib. Int J Dermatol. 2023;62(2):61–3. DOI: https://doi.org/10.1111/ijd.16342

Passeron T, Ezzedine K, Hamzavi I, van Geel N, Schlosser BJ, Wu X, et al. Once-daily upadacitinib versus placebo in adults with extensive non-segmental vitiligo: a phase 2, multicentre, randomised, double-blind, placebo-controlled, dose-ranging study. E Clin Med. 2024;73:102655 DOI: https://doi.org/10.1016/j.eclinm.2024.102655

Magdaleno-Tapial J, Hernández-Bel P, Esteve-Martínez A, Peñuelas-Leal R, Labrandero-Hoyos C, Sánchez-Carazo JL. Upadacitinib and its role in the treatment of vitiligo: A new possible therapeutic perspective. JAAD Case Rep. 2024;46:57–58. DOI: https://doi.org/10.1016/j.jdcr.2024.01.033

Berardinis AD, Esposito M, Fargnoli MC. Upadacitinib Monotherapy in Vitiligo Associated with Atopic Dermatitis: Killing Two Birds with One Stone. Case Rep Dermatol. 2025;17(1):91–5. DOI: https://doi.org/10.1159/000544703

Pan T, Mu Y, Shi X, Chen L. Concurrent vitiligo and atopic dermatitis successfully treated with upadacitinib: a case report. J Dermatolog Treat. 2023;34:2200873. DOI: https://doi.org/10.1080/09546634.2023.2200873

Ezzedine K, Soliman AM, Rosmarin D, Pandya AG, Schlosser Bethanee J, van Geel N. 500 - Patient-reported outcomes following 24 weeks of treatment with upadacitinib in adults with non-segmental vitiligo: results from a phase 2, randomized, double-blind, dose-ranging study. Br J Dermatol. 2024;190(2):64–5. DOI: https://doi.org/10.1093/bjd/ljad498.065

Mu Y, Pan T, Chen L. Treatment of Refractory Segmental Vitiligo and Alopecia Areata in a Child with Upadacitinib and NB-UVB: A Case Report. Clin, Cosm Invest Dermatol. 2024;17:1789-92. DOI: https://doi.org/10.2147/CCID.S467026