Addition of Narrow-Band UVB Phototherapy to Ruxolitinib Cream in Patients With Vitiligo

Pandya, Amit G.; Harris, John E.; Lebwohl, Mark; Hamzavi, Iltefat; Butler, Kathleen; Kuo, Fiona; Wei, Shaoceng; Rosmarin, David

doi:10.1016/j.jid.2022.05.1093

Cited by 16 publications

(9 citation statements)

References 8 publications

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“…7B ). This data indicates that the combination of a JAK inhibitor with UVB irradiation may be a more effective repigmentation method, consistent with a recent small sample study which reported that UVB irradiation improved the repigmentation effect of ruxolitinib in patients 66 .…”

Section: Resultssupporting

confidence: 90%

Sexual dimorphism in melanocyte stem cell behavior reveals combinational therapeutic strategies for cutaneous repigmentation

An,

Kim,

Donahue

et al. 2024

Nat Commun

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Vitiligo is an autoimmune skin disease caused by cutaneous melanocyte loss. Although phototherapy and T cell suppression therapy have been widely used to induce epidermal re-pigmentation, full pigmentation recovery is rarely achieved due to our poor understanding of the cellular and molecular mechanisms governing this process. Here, we identify unique melanocyte stem cell (McSC) epidermal migration rates between male and female mice, which is due to sexually dimorphic cutaneous inflammatory responses generated by ultra-violet B exposure. Using genetically engineered mouse models, and unbiased bulk and single-cell mRNA sequencing approaches, we determine that manipulating the inflammatory response through cyclooxygenase and its downstream prostaglandin product regulates McSC proliferation and epidermal migration in response to UVB exposure. Furthermore, we demonstrate that a combinational therapy that manipulates both macrophages and T cells (or innate and adaptive immunity) significantly promotes epidermal melanocyte re-population. With these findings, we propose a novel therapeutic strategy for repigmentation in patients with depigmentation conditions such as vitiligo.

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Section: Resultssupporting

confidence: 90%

Sexual dimorphism in melanocyte stem cell behavior reveals combinational therapeutic strategies for cutaneous repigmentation

An,

Kim,

Donahue

et al. 2024

Nat Commun

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“…During the open‐label phase starting at Week 104 of the study, optional concomitant NB‐UVB therapy was permitted at different frequencies depending on the different centres. Among the 19 patients who added 12 weeks of NB‐UVB therapy, the combination was well tolerated and the addition of NB‐UVB improved facial and total body repigmentation 21 …”

Section: Clinical Trialsmentioning

confidence: 99%

“…Among the 19 patients who added 12 weeks of NB-UVB therapy, the combination was well tolerated and the addition of NB-UVB improved facial and total body repigmentation. 21 Phase III trial NCT04052425 TRuE-V1 and NCT0457573 TRuE-V2…”

Section: Route Of Administration Topicalmentioning

confidence: 99%

Topical ruxolitinib: A new treatment for vitiligo

Tavoletti

Avallone

Conforti

et al. 2023

Acad Dermatol Venereol

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Vitiligo is a chronic autoimmune skin disorder whose diagnosis is often psychologically upsetting. The efficacy of the available therapies, including topical corticosteroids and topical calcineurin inhibitors, has historically been limited and the management of vitiligo is still challenging. As vitiligo is a chronic disease limited to the skin, topical rather than systemic therapies may be preferable (especially among patients with localised lesions) to avoid the long‐term side‐effects of the latter. A topical formulation of ruxolitinib, a selective JAK1/2 inhibitor, has recently been approved in the United States for the treatment of non‐segmental vitiligo in patients aged >12 years based on data from the phase III TRuE‐V1 and TRuE‐V2 clinical trials. The aim of this review is to describe the current evidence concerning the efficacy and safety of topical ruxolitinib in the treatment of vitiligo, and discuss issues regarding its use in younger children and pregnant or breastfeeding women, as well as the duration and durability of treatment. The promising results obtained so far suggest that 1.5% ruxolitinib cream is an effective means of treating vitiligo.

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“…theoretical increased risk of skin cancer and other malignancies). The following options are reported: Phototherapy with topicals: Generally, the combination of phototherapy with topicals (both calcineurin inhibitors, topical steroids and topical ruxolitinib) achieves better efficacy 40‐44 . As to which combination is better, the number of published studies is currently too limited to make a fair judgment. Combination with systemic antioxidants: There is some evidence to recommend the combination of phototherapy with oral antioxidants like polypodium leucotomos and gliadin‐protected SuperOxide Dismutase (SOD) for achieving better repigmentation 45‐47 …”

Section: Treatment Recommendationsmentioning

confidence: 99%

Worldwide expert recommendations for the diagnosis and management of vitiligo: Position statement from the International Vitiligo Task Force Part 1: towards a new management algorithm

van Geel,

Speeckaert,

Taïeb

et al. 2023

Acad Dermatol Venereol

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BackgroundThe treatment of vitiligo can be challenging and depends on several factors such as the subtype, disease activity, vitiligo extent, and treatment goals. Vitiligo usually requires a long‐term approach. To improve the management of vitiligo worldwide, a clear and up‐to‐date guide based on international consensus with uniform stepwise recommendations is needed.ObjectivesTo reach an international consensus on the nomenclature and to develop a management algorithm for the diagnosis, assessment, and treatment of vitiligo.MethodsIn this consensus statement, a consortium of 42 international vitiligo experts and four patient representatives participated in online and live meetings to develop a consensus management strategy for vitiligo. At least two vitiligo experts summarized the evidence of topics included in the algorithms. A survey was utilized to resolve remaining issues among a core group of eight experts. Subsequently, the unanimous recommendations were finalized and validated based on further input from the entire group during two live meetings.ResultsThe algorithms highlight the importance of shared decision‐making. Dermatologists are encouraged to provide patients with detailed explanations of the prognosis and expected therapeutic outcomes based on clinical examination. The treatment goal should be discussed and clearly emphasized to patients given the different approaches for disease stabilization and repigmentation. The evaluation of disease activity remains a cornerstone in the tailor‐made approach to vitiligo patients.ConclusionsThese new treatment algorithms are intended to guide clinical decision‐making in clinical practice. Promising novel therapies for vitiligo are on the horizon, further highlighting the need for reliable outcome measurement instruments and greater emphasis on shared decision‐making.

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Addition of Narrow-Band UVB Phototherapy to Ruxolitinib Cream in Patients With Vitiligo

Cited by 16 publications

References 8 publications

Sexual dimorphism in melanocyte stem cell behavior reveals combinational therapeutic strategies for cutaneous repigmentation

Sexual dimorphism in melanocyte stem cell behavior reveals combinational therapeutic strategies for cutaneous repigmentation

Topical ruxolitinib: A new treatment for vitiligo

Worldwide expert recommendations for the diagnosis and management of vitiligo: Position statement from the International Vitiligo Task Force Part 1: towards a new management algorithm

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