Repigmentation in Vitiligo With Tofacitinib May Require Concomitant Light Exposure

In patients with vitiligo, treatment with the Janus kinase (JAK) inhibitor tofacitinib resulted in repigmentation when given concomitantly with light exposure, according to a retrospective case series published in Journal of the American Academy of Dermatology.

To evaluate the efficacy of the treatment, researchers assessed 10 consecutive patients with vitiligo treated with tofacitinib. Severity of disease was assessed by body surface area (BSA) of depigmentation both prior to and at the end of treatment. Participants received tofacitinib 5 to 10 mg once or twice daily for an average of 9.9 months.

Of the 10 consecutive tofacitinib-treated patients, 5 achieved some repigmentation (mean decrease of 5.4% BSA involvement with vitiligo) at sites that received either sunlight exposure or low-dose narrowband ultraviolet B phototherapy. Among the 5 patients who did not experience any repigmentation, only 1 had significant sunlight exposure; the others had either avoided sunlight or had practiced photoprotection.

Suction blister sampling was performed in one of the patients prior to initiation of tofacitinib therapy and then 10 months later to assess changes in T-cell recruitment and chemokine expression. This particular patient had initially responded to tofacitinib therapy but had a relapse after stopping treatment.

Several important findings emerged from this study. First, for tofacitinib treatment to be effective in patients with vitiligo, light exposure seems to be required, and low doses may be sufficient. Second, repigmentation may be achieved following depigmentation recurrence associated with discontinuation of tofacitinib. Third, areas of repigmentation appear to be maintained with tofacitinib monotherapy after stopping light exposure.

These findings support a model in which JAK inhibitors suppress T-cell mediators of vitiligo, and light exposure is needed for the stimulation of melanocyte regeneration. Prospective clinical trials are warranted to further assess the use of JAK inhibitors for the treatment of vitiligo.

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Reference

Liu LY, Strassner JP, Refat MA, Harris JE, King BA. Repigmentation in vitiligo using the Janus kinase inhibitor tofacitinib may require concomitant light exposure. J Am Acad Dermatol. 2017;77:675-682.e.1