Evaluating Efficacy of Ritlecitinib With or Without nbUVB in Treating Non-Segmental Vitiligo

Ritlecitinib, a JAK3/TEC family kinase inhibitor, has shown promising results in the treatment of non-segmental vitiligo (NSV), according to a recent Phase 2b trial’s poster presentation at the Revolutionizing Atopic Dermatitis (RAD) June 2024 meeting.

The study aimed to assess the efficacy and tolerability of ritlecitinib with or without narrow band ultraviolet B (nbUVB) add-on therapy. The trial involved a 24-week placebo-controlled dose-ranging period followed by treatment with ritlecitinib. Patients were administered 200 mg of ritlecitinib for the first 4 weeks, then 50 mg for the remaining 20 weeks, with some receiving additional nbUVB phototherapy twice a week. To manage missing data, both observed case (OC) and last observation carried forward (LOCF) methods were employed.

In total, 230 patients participated, with 43 receiving the combined ritlecitinib and nbUVB treatment and 187 receiving ritlecitinib monotherapy. Also, 9 patients in the combination group discontinued due to not meeting the specific efficacy criteria of more than 10% improvement in the total vitiligo area scoring index (T-VASI) at Week 12.

The results at Week 24 indicated that the mean percent change from baseline (CFB) in the facial vitiligo area scoring index (F-VASI) was -69.6% for the combination therapy group compared to -55.1% for the monotherapy group (OC; P=0.009). Although the LOCF method showed a reduction in significance (-57.0% vs -51.5%; P=0.158), the combination therapy still demonstrated higher efficacy.

Moreover, 60.9% of patients in the combination group achieved at least a 75% improvement in F-VASI compared to 29.2% in the monotherapy group (OC; P=0.007). For T-VASI, the combination therapy group saw a mean CFB of -46.8% versus -24.5% in the monotherapy group (OC; P<0.001), with LOCF results showing -29.4% versus -21.2% (P=0.043). Additionally, 50.0% of patients in the combination group achieved at least a 50% improvement in T-VASI compared to 15.2% in the monotherapy group (OC; P<0.001).

The study concluded that ritlecitinib, both alone and in combination with nbUVB, significantly improved facial and total body repigmentation in patients with NSV and was well-tolerated with no new safety signals. These findings suggest that the addition of nbUVB may enhance the efficacy of ritlecitinib in treating NSV.

Reference:

Yamaguchi Y, Peeva E, Adiri R, Ghosh P, et al. Response to ritlecitinib with or without narrow band ultraviolet B (nbUVB) add-on therapy in patients with active non-segmental vitiligo (NSV). Poster presented at: Revolutionizing Atopic Dermatitis; June 8-10, 2024; Chicago, IL.