Understanding and Treating Vitiligo - Episode 6

Emerging Agents for the Treatment of Vitiligo

Dr Amit G. Pandya discusses novel drugs in the pipeline for the treatment of vitiligo.

Amit G. Pandya, MD, FAAD: This is an exciting time for me and the treatment of vitiligo. In my entire career, I have not seen studies for actual drugs to treat vitiligo that have progressed so far as they have today. We now have multiple topical and oral medications that are being studied for the treatment of vitiligo, and hopefully, ultimately, we’ll get FDA approval for treatment. One of these medications is topical ruxolitinib, which is a topical JAK inhibitor. This has already completed phase 3 studies, and over 50% of the patients who were treated got over 50% of the color back on their face, what we call a F-VASI50 [50% improvement in Facial Vitiligo Area Scoring Index] after 6 months of application. This is the cream, without phototherapy treatment. This is exciting, that a cream applied twice a day for 6 months can get over half the color back on your face with no other treatment. On the body, after 6 months, there was about 25% repigmentation overall with just the cream. I’m sure that with phototherapy, we will see much higher responses. There’s also an oral JAK inhibitor that’s being studied by Incyte Corp that is in phase 2 studies. It will be exciting to see the result of that.

Recently, there have been reports of an oral JAK inhibitor from Pfizer. This one, ritlecitinib, achieved its goals, its primary outcome measure, in that the oral JAK inhibitor was better than placebo at the end of the 6-month study. After 6 months, there was about 25% repigmentation, but after 12 months, it was more like 60% to 70% repigmentation of the face just with this oral JAK. There is also an anti–IL-15 [interleukin-15] antibody study that’s ongoing. We don’t know the results of that, but this is designed to affect the resident memory T cells, which are considered the reason why vitiligo comes back in the exact same spot when it returns. By removing these resident memory T cells, perhaps one can have durable remission. This anti–IL-15 antibody, which is a subcutaneous injection, is an exciting study, and hopefully we’ll see the results of that soon.

Finally, afamelanotide is a melanocyte-stimulating hormone analogue, which was studied several years ago. It was found that when you combine afamelanotide, which is an implant that is applied underneath the skin, with narrowband UV-B [ultraviolet B] therapy, you get faster results when it comes to repigmentation and stimulation of the melanocytes, than using narrowband UV-B alone. There are many studies that are ongoing, several have been completed. I’m looking forward to seeing our new armamentarium for vitiligo in the near future.

Transcript Edited for Clarity