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

Vitiligo is a chronic autoimmune disease resulting in patches of skin depigmentation ( Taïeb and Picardo, 2009 Taïeb A. Picardo M. Clinical practice. Vitiligo. N Engl J Med. 2009; 360: 160-169 Crossref PubMed Scopus (297) Google Scholar ) and reduced QOL ( Morrison et al., 2017 Morrison B. Burden-Teh E. Batchelor J.M. Mead E. Grindlay D. Ratib S. Quality of life in people with vitiligo: a systematic review and meta-analysis. Br J Dermatol. 2017; 177: e338-e339 Crossref PubMed Scopus (25) Google Scholar ). Disease pathogenesis is driven by IFN-γ signaling through Jak1 and 2 ( Rashighi and Harris, 2015 Rashighi M. Harris J.E. Interfering with the IFN-γ/CXCL10 pathway to develop new targeted treatments for vitiligo. Ann Transl Med. 2015; 3: 343 PubMed Google Scholar ). Combination phototherapy with topical corticosteroids or topical calcineurin inhibitors has been shown to significantly improve repigmentation versus monotherapy in patients with vitiligo ( Batchelor et al., 2020 Batchelor J.M. Thomas K.S. Akram P. Azad J. Bewley A. Chalmers J.R. et al. Home-based narrowband UVB, topical corticosteroid or combination for children and adults with vitiligo: HI-light vitiligo three-arm RCT. Health Technol Assess. 2020; 24: 1-128 Crossref PubMed Scopus (11) Google Scholar ; Dong et al., 2021 Dong Y. Yang Q. Guo B. Zhu J. Sun X. The effects of tacrolimus plus phototherapy in the treatment of vitiligo: a meta-analysis. Arch Dermatol Res. 2021; 313: 461-471 Crossref PubMed Scopus (5) Google Scholar ). Previous reports with Jak inhibitors have suggested additional therapeutic benefits with concomitant phototherapy ( Joshipura et al., 2018 Joshipura D. Alomran A. Zancanaro P. Rosmarin D. Treatment of vitiligo with the topical Janus kinase inhibitor ruxolitinib: a 32-week open-label extension study with optional narrow-band ultraviolet B. J Am Acad Dermatol. 2018; 78: 1205-1207.e1 Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar ; Liu et al., 2017 Liu L.Y. Strassner J.P. Refat M.A. Harris J.E. King B.A. Repigmentation in vitiligo using the Janus kinase inhibitor tofacitinib may require concomitant light exposure. J Am Acad Dermatol. 2017; 77: 675-682.e1 Abstract Full Text Full Text PDF PubMed Scopus (119) Google Scholar ). In these patients, it has been proposed that Jak inhibition suppresses inflammatory signals that result in melanocyte destruction, leading to the potential recovery of melanocytes that may be enhanced during phototherapy-induced stimulation ( Liu et al., 2017 Liu L.Y. Strassner J.P. Refat M.A. Harris J.E. King B.A. Repigmentation in vitiligo using the Janus kinase inhibitor tofacitinib may require concomitant light exposure. J Am Acad Dermatol. 2017; 77: 675-682.e1 Abstract Full Text Full Text PDF PubMed Scopus (119) Google Scholar ). Ruxolitinib is a Jak1/Jak2 inhibitor ( Quintás-Cardama et al., 2010 Quintás-Cardama A. Vaddi K. Liu P. Manshouri T. Li J. Scherle P.A. et al. Preclinical characterization of the selective JAK1/2 inhibitor INCB018424: therapeutic implications for the treatment of myeloproliferative neoplasms. Blood. 2010; 115: 3109-3117 Crossref PubMed Scopus (622) Google Scholar ), and a topical formulation is in development for the treatment of vitiligo. In a phase 2, randomized, dose-ranging study in 157 adult patients with vitiligo (NCT03099304), ruxolitinib cream was associated with substantial repigmentation over 52 weeks and was well tolerated ( Rosmarin et al., 2020 Rosmarin D. Pandya A.G. Lebwohl M. Grimes P. Hamzavi I. Gottlieb A.B. et al. Ruxolitinib cream for treatment of vitiligo: a randomised, controlled, phase 2 trial. Lancet. 2020; 396: 110-120 Abstract Full Text Full Text PDF PubMed Scopus (104) Google Scholar ). In this study, we report the safety and efficacy of ruxolitinib cream with concomitant narrow-band UVB (NB-UVB) phototherapy during the open-label phase after week 52 of the phase 2 study.