Real-World Study Highlights a Need to Improve Treatment Initiation in Patients With Vitiligo

Literature indicates that the treatment of vitiligo is often associated with numerous challenges, low rates of adherence, and high rates of discontinuation due to the limitations and adverse effects associated with standard treatment options that include systemic or topical corticosteroids or topical calcineurin inhibitors, in association with the use of phototherapy and vitamin D. In July 2022, the FDA approved the topical JAK inhibitor, ruxolitinib cream, as the first and only regimentation treatment for nonsegmental vitiligo for those 12 years and older who are not immunocompromised which offer a therapeutic option to improve clinical outcomes and overall patient quality of life.

In a recent publication in Dermatology and Therapy, authors sought to assess the utilization of therapies and the treatment patterns employed in patients with vitiligo during the first year after obtaining a vitiligo diagnosis. Between October 1, 2016, and April 30, 2021, researchers gathered data from patients newly diagnosed with vitiligo aged ≥ 12 years from the Merative^® MarketScan Research Databases. The authors noted that patients also received ≥ 12 months of continuous enrollment before and after vitiligo diagnosis and medication use, treatment line of therapy, time to and quantity of medication claims, and duration of therapy were documented in the 12 months post-vitiligo diagnosis.

The researchers categorized results based on the following: 1) treatment initiators post-vitiligo diagnosis, 2) patients with moderate-to-severe vitiligo, and 3) adolescents (aged 12–17 years).

Treatments identified in this study included corticosteroid treatment, topical tacrolimus treatment, ultraviolet light therapy, photochemotherapy, laser therapy, excimer laser therapy, and epidermal skin graft.

The study involved 19,355 patients with vitiligo, and of that patient population, 49.9%, representing 9,648 patients, did not obtain treatment during the 12-month follow-up period. Results also revealed that in the 12 months post-vitiligo, “Switching was minimal among treatment initiators (N = 5845).” Additionally, results revealed that the most frequently used initial therapies were high-potency topical corticosteroids, oral corticosteroids, and topical calcineurin inhibitors (TCI), with rates reported as 25.4%, 23.1%, and 14.7%, respectively.

Results also revealed that among the adolescent population initiating treatment (N=486), the most common therapy prescribed was TCI (30.9%) as first-line therapy, and patients classified as having moderate-to-severe vitiligo (N=3462) were more likely to get therapy during follow-up, with only 1.5% not receiving treatment.

Additionally, the authors wrote, “Among patients with no vitiligo treatment prior to diagnosis, time to first medication claim ranged from 51.9 days (standard deviation [SD], 84.0) for TCI to 178.6 days (SD 116.0) for systemic immunosuppressants; mean total days supplied ranged from 14.4 days (SD 27.1) for oral corticosteroids to 121.0 (SD 114.0) for immunosuppressants.”

Based on their findings, the authors concluded that a large percentage of patients with vitiligo did not obtain therapy, and within the first year of diagnosis, among those patients who received therapy, the majority were unlikely to change or use a combination of treatments. The authors wrote, “To help better understand the needs of patients with vitiligo, future studies need to examine which demographic and clinical characteristics are associated with not receiving treatments for vitiligo.”

Conclusion

This study demonstrates that vitiligo is undertreated and highlights the need to expand awareness about the recently FDA-approved topical therapy for non-segmental vitiligo. Since nonsegmental vitiligo is the most common type of vitiligo, the availability of the targeted therapy, Opzelura (topical ruxolitinib) cream, has the potential to help many patients living with vitiligo when appropriate. Improving access to therapy and patient adherence starts with identifying ideal candidates for this novel therapy and educating patients about its efficacy and safety.

Reference

Rosmarin D, Soliman AM, Li C. Real-World treatment patterns in patients with vitiligo in the United States. Dermatol Ther (Heidelb). 2023;13(9):2079-2091. doi:10.1007/s13555-023-00983-3