Treatment of refractory progressive vitiligo with oral upadacitinib and narrow‐band ultraviolet‐B: A case series

Vitiligo, a common autoimmune-mediated disease, is characterized by the presence of depigmented patches on the skin. Conventional treatments are often insufficient for some patients, especially those with a body surface area (BSA) involvement exceeding 5%. Recent pharmacological advances have highlighted the potential of oral Janus kinase (JAK) inhibitors, particularly tofacitinib,1 baricitinib,2 and upadacitinib,3 in the treatment of vitiligo. This study aimed to explore the effects of oral upadacitinib combined with narrow-band ultraviolet B (NB-UVB) therapy on patients with refractory or progressive vitiligo. We prospectively enrolled eight vitiligo patients who were undergoing treatment in the Department of Shandong Provincial Hospital for Skin Diseases, Shandong First Medical University, from June 2023 to September 2024. All patients who had previously failed NB-UVB therapy for at least 3 months or who declined oral glucocorticoids during the progressive stage were included. After excluding patients with contraindications and obtaining informed consent, the patients were prescribed oral upadacitinib at a dosage of 15 mg once daily for 24 weeks. The dosage of upadacitinib of 15 mg every other day at week 16 for an additional 8 weeks was reduced in two patients (25%) who were <18 years of age. Clinical evaluations were scored using the Vitiligo Area Scoring Index (VASI). The percentage improvement represents the T-VASI difference before and after treatment. Serum levels of CXCL10 and CXCL12 were determined using flow cytometry. Clinical and laboratory evaluations were performed at 3- intervals throughout the follow-up period. The demographic, clinical characteristics and treatment outcomes of all patients are presented in Table 1 (patient 3 and patient 8 are segmental vitiligo; the others are non-segmental vitiligo). The average VASI score decreased from 7.18 ± 6.03 at baseline to 2.13 ± 2.03 at Month 6 (p = 0.012). The average percentage improvement was 65.41% ± 15.75% at Month 6 compared to 7.48% ± 8.78% at Month 1. Among the eight patients, four (50%) achieved T-VASI75 repigmentation, three (37.5%) achieved T-VASI50 repigmentation and one patient (12.5%) achieved T-VASI25 repigmentation, representative photos of which are shown in Figure 1. The white blood cell count and liver function did not decrease during the treatment. Only three patients reported adverse events during the treatment, all of which were mild acne. The combination of upadacitinib and NB-UVB may be an effective treatment regimen for refractory or progressive vitiligo. Within the first month of treatment, disease progression in all patients was well-controlled with observed repigmentation. Previous research indicates that 6 months of narrow-band UVB therapy is effective for vitiligo with a relative VASI reduction of 33.26% (95% CI, 24.18%–42.33%).4 The time to onset of repigmentation in the NB-UVB monotherapy group for facial and upper extremity lesions was 61.0 and 69.0 days, respectively.4 The average VASI improvement with oral upadacitinib alone was reported as 41.90% ± 8.87% after 6 months of treatment.3 Our findings suggest that the combination of upadacitinib and NB-UVB therapy may yield superior VASI improvement compared to either monotherapy, especially for patients with BSA involvement >5%. Serum CXCL10 and CXCL12 might represent biomarkers for treatment efficacy but need further validation in a large sample size. Future clinical trials may be developed to compare upadacitinib monotherapy and upadacitinib plus NB-UVB therapy for patients with refractory or progressive vitiligo. This work was supported by the Taishan Scholars Program of Shandong Province (tsqn201909141), the Medical Health Science and Technology Project of Shandong Province (202320000589, 202320000617). None declared. Reviewed and approved by SPIDV IRB; approval #2023001207. The patients or their parents/guardians in this manuscript have given written informed consent to the publication of their case details. The data that support the findings of this study are available from the corresponding author upon reasonable request.