VITILIGO is a chronic autoimmune condition characterised by skin depigmentation, significantly affecting patients’ quality of life (QOL). Treating individuals with severe and active disease remains a substantial challenge. A recent academic, multicentre, double-blind randomised clinical trial aimed to evaluate the efficacy and safety of combining baricitinib, a Janus kinase inhibitor, with narrowband UV-B phototherapy in adults with severe, active, nonsegmental vitiligo. The study was conducted across four dermatology departments from July 2021 to April 2023 and included 49 participants. Data analysis was completed between August and November 2023.
Participants were randomised 3:1 to receive either 4 mg of baricitinib daily or a placebo for 36 weeks. During the first 12 weeks, treatments were administered alone, followed by combination therapy with narrowband UV-B twice weekly from weeks 12 to 36. The primary measure of efficacy was the mean percentage change in the Vitiligo Area Scoring Index (VASI) from baseline to week 36. Researchers aimed to demonstrate that the combined treatment surpassed a 42.9% repigmented surface threshold, previously associated with narrowband UV-B monotherapy. Adverse events, changes in disease activity, and QOL were also assessed.
Among the participants, 35 (71%) were female, with a median age of 49.9 years. Of the 49 patients, 37 were allocated to the baricitinib group and 12 to the placebo group. The baricitinib group achieved a mean VASI reduction of −44.8% at week 36, compared with −9.2% in the placebo group. While this reduction did not significantly exceed the pre-defined threshold, post hoc analysis revealed a significant difference between the baricitinib plus narrowband UV-B group and the placebo group (P = .02). Additionally, patients in the baricitinib group experienced greater improvements in disease activity and QOL without a significant increase in adverse events.
These findings highlight the potential of baricitinib combined with narrowband UV-B to improve outcomes in patients with severe vitiligo, though further studies are needed to refine treatment strategies.
Katie Wright, EMJ
Reference
Seneschal J et al. Combination of baricitinib and phototherapy in adults with active vitiligo: a randomized clinical trial. JAMA Dermatol. 2025;DOI:10.1001/jamadermatol.2024.5737.
