Ritlecitinib Stabilizes Vitiligo in Tranquillo Trial, With Iltefat Hamzavi, MD

Repigmentation in vitiligo follows a fundamentally slower timeline than improvement in psoriasis or atopic dermatitis, and stabilizing the disease may be among the most meaningful outcomes of the phase 3 Tranquillo program, according to Iltefat H. Hamzavi, MD.

In a second segment of his interview with HCPLive at the 2026 European Academy of Dermatology and Venereology (EADV) Congress in Vienna, Hamzavi walked through the trial results for ritlecitinib and what they could mean for practice. Hamzavi, of the Multicultural Dermatology Center at Henry Ford Health and Hamzavi Dermatology Specialists in Detroit, Michigan, is first author on the late-breaking abstract.¹

What Did the Tranquillo Trials Show for Ritlecitinib in Vitiligo?

Hamzavi explained vitiligo trials typically assess 2 primary areas: facial involvement, measured by the Facial Vitiligo Area Scoring Index (F-VASI), and total body involvement, measured by the Total VASI (T-VASI). The facial end point carries particular weight because of the stigma associated with visible facial lesions, a priority the US Food and Drug Administration (FDA) adopted with input from patient and physician communities.

Facial responses were stronger. In Tranquillo 2 Part Ia, 21.9% of patients receiving ritlecitinib 100 mg achieved F-VASI75 at week 52 versus 2.4% with placebo, and 13.0% versus 2.4% achieved T-VASI50.¹

Hamzavi attributed the faster facial response partly to hair follicle density, which he described as a likely reservoir for repigmentation. Areas such as the fingertips, which lack follicles, tend to respond more slowly.

The program also compared 50 mg and 100 mg doses, with the higher dose performing modestly better in some domains. Patient- and physician-reported outcomes, including stigmatization measured by the Vitiligo Noticeability Scale, improved over 52 weeks.

Why Does Response Take Longer in Vitiligo?

Hamzavi described vitiligo as comparable to a stroke of the skin. Melanocytes originate from the neural crest, and once these cells are destroyed, recovery takes far longer than in keratinocyte-driven conditions, where patients often improve within 6 to 8 weeks.

In Tranquillo, separation from placebo took about 6 months to emerge, and the pace of improvement was still accelerating near week 52, he noted.

He highlighted disease stabilization as one of the most notable findings. Roughly 80% of patients receiving ritlecitinib remained stable compared with about 60% with placebo, he said, framing the halt of progression as a major achievement given the nerve-derived nature of melanocytes.

He added an oral option could serve patients with more than 10% body surface area involvement, beyond the typical reach of topical agents.

What Does Hamzavi Expect Next for Vitiligo Treatment?

Hamzavi anticipates Tranquillo, alongside other systemic agents in development, will open the door to more vitiligo-specific approaches. Clinicians cannot evaluate the disease through a psoriasis or atopic dermatitis lens, he argued.

He noted responses may continue beyond the standard 52-week window and suggested phototherapy could be combined with systemic agents to enhance repigmentation. Using a driving analogy, he said the field now has the instruments to measure progress, including the right end points and an understanding of what they mean.

Hamzavi characterized the trial as an important first step in the right direction, with considerable work still ahead.

Editor’s note: This summary has been edited for grammar and clarity using artificial intelligence tools. Hamzavi is a consultant for AbbVie, Pfizer, Incyte, UCB, Boehringer Ingelheim, Sonoma, Merck, Takeda,Teva, Novartis, Jansen, Avita, Galderma, Vimela, and Almirall; an investigator for Pfizer, Incyte, Avita, L'Oréal/La Roche-Posay, ITN, and AbbVie; and a board member and past president of the Hidradenitis Suppurativa and Global Vitiligo foundations.

References

1. Hamzavi I, Rosmarin D, Passeron T, et al. Efficacy and safety of ritlecitinib in patients with nonsegmental vitiligo (NSV): results from the Tranquillo 2 Part Ia and Tranquillo phase 3 randomized, double-blind, placebo-controlled, multicenter clinical trials. Abstract LB-161. Presented at: 2026 European Academy of Dermatology and Venereology Congress; September 30-October 3, 2026; Vienna, Austria.