Study Underscores Safety and Efficacy of Baricitinib with NB-UVB in Vitiligo

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Vitiligo often coexists with other autoimmune conditions, necessitating a more comprehensive understanding of potential treatment options.¹ A recent study investigated developments in vitiligo treatment, particularly the use of Janus kinase (JAK) inhibitors, and discussed the efficacy and safety of combining baricitinib, an oral JAK1/2 inhibitor, with narrow-band ultraviolet B (NB-UVB) phototherapy in patients with progressive non-segmental vitiligo (NSV).² 

Study Overview: Baricitinib and NB-UVB Phototherapy for Vitiligo

The open-label study conducted at Peking Union Medical College Hospital assessed the combination of baricitinib and NB-UVB phototherapy in patients with progressive NSV. This study included patients aged 18 to 60 years who had received no systemic treatments or phototherapy in the previous 4 weeks. The study enrolled 36 patients, who were divided into 2 groups: 1 group received baricitinib (2 mg/day) along with NB-UVB 3 times a week, while the control group received NB-UVB alone. This study aimed to evaluate the effectiveness of baricitinib in conjunction with NB-UVB compared to phototherapy alone.

The study's primary endpoint was the proportion of patients achieving a 50% improvement in the total Vitiligo Area Scoring Index (T-VASI50) at 16 weeks. Key secondary outcomes included achieving 75% improvement in the facial VASI (F-VASI75), mean percentage changes in T-VASI, and a physician's global vitiligo assessment (PhGVA) response of "clear" or "almost clear."

Results

After 16 weeks, results showed that the combination therapy was “significantly” more effective than NB-UVB alone. In the combination group, researchers reported 70.6% of patients achieved T-VASI50, compared to only 12.5% in the control group (p < 0.001). Additionally, 93.3% of combination group patients achieved F-VASI75, indicating that combining baricitinib with NB-UVB enhanced repigmentation outcomes for facial and other non-acral areas. The study stated the response was noticeable as early as week 4, suggesting that baricitinib accelerates the onset of repigmentation when combined with phototherapy. In contrast, the control group showed a slower, less pronounced response, with some patients even experiencing disease progression.

The study also highlighted that the facial area responded more readily to treatment, while acral regions were less responsive. Researchers stated this regional variability in response may be attributed to factors like hair follicle density, which is higher on the face and contributes to better outcomes.³

Safety and Tolerability

The safety profile of baricitinib combined with NB-UVB was favorable, researchers wrote, with no serious adverse events reported. In the combination group, some patients experienced mild adverse events, including erythema and blistering following phototherapy and mild acne on the chest and back, possibly related to baricitinib. The study noted these events did not lead to treatment discontinuation. Laboratory monitoring showed no significant alterations in hematological or biochemical parameters, underscoring the tolerability of this low-dose baricitinib regimen combined with NB-UVB.

Discussion

Researchers stated the positive outcomes of combining baricitinib and NB-UVB may be linked to the dual action on vitiligo pathogenesis: baricitinib mitigates the autoimmune attack on melanocytes, while NB-UVB stimulates melanocyte migration from hair follicles to repigmented areas. These results align with prior research, suggesting that JAK inhibitors in combination with phototherapy may yield a "1 plus 1 greater than 2" effect.⁴ Researchers said this treatment modality allows for faster, more extensive repigmentation, potentially enhancing patients’ quality of life through improved aesthetic outcomes and reducing the psychological burden associated with slow, incomplete repigmentation. Despite its promising results, researchers noted this study has limitations, including a small sample size, a non-randomized design, and a short treatment period. Additionally, they stated long-term outcomes related to relapse rates and quality of life impacts require further investigation.

Conclusion

The study found that combining baricitinib and NB-UVB phototherapy is a promising treatment strategy for patients with progressive NSV, providing faster, more extensive repigmentation compared to NB-UVB alone. This approach could be especially beneficial for patients with widespread vitiligo who may not respond as well to topical therapies alone. Given the increasing understanding of the JAK-STAT pathway in vitiligo, researchers suggested JAK inhibitors, particularly oral formulations like baricitinib, may represent a significant advancement in vitiligo management. They noted that further research on optimal dosing, long-term safety, and quality-of-life outcomes will be essential to fully establish this combination as a standard treatment for vitiligo.

Reference

1. Ezzedine K, Eleftheriadou V, Jones H, et al. Psychosocial effects of vitiligo: A systematic literature review. Am J Clin Dermatol. 2021;22(6):757-774. doi:10.1007/s40257-021-00631-6
2. Hu Z, Lu L, Feng J, et al. Low-dose baricitinib plus narrow-band ultraviolet B for the treatment of progressive non-segmental vitiligo: A prospective, controlled, open-label study. Pigment Cell Melanoma Res. Published online October 23, 2024. doi:10.1111/pcmr.13209
3. Esmat SM, El-Tawdy AM, Hafez GA, et al. Acral lesions of vitiligo: why are they resistant to photochemotherapy?.J EurAcad Dermatol Venereol. 2012;26(9):1097-1104. doi:10.1111/j.1468-3083.2011.04215.x
4. McKesey J, Pandya AG. A pilot study of 2% tofacitinib cream with narrowband ultraviolet B for the treatment of facial vitiligo. J Am Acad Dermatol. 2019;81(2):646-648. doi:10.1016/j.jaad.2019.04.032