Dr. Ahmed
Rinvoq for Vitiligo: Rinvoq is the brand name of Upadicitinib, a potent and selective JAK (Janus kinase) inhibitor. It selectively blocks JAK-1 vs JAK-2, JAK-3, and TYK-2.
Rinvoq is indicated for numerous autoimmune rheumatic diseases. The drug is being investigated for treating Vitiligo and has so far been successful in the early phases of clinical trials.
Vitiligo is a common problem worldwide. Several topical and systemic treatment options are available thanks to continuous research.
Because vitiligo is primarily an immune-mediated disease, most treatment options target a person’s self immune pathways.
What is Rinvoq (Upadicitinib)?
Rinvoq is the brand name of Upadicitinib. It is an orally available JAK inhibitor, approved first in 2019 by the FDA for Rheumatoid Arthritis.
This medication is being manufactured by AbbVie scientists. It has received FDA approval for the following indications [Ref]:
- Moderately severe Rheumatoid Arthritis
- Psoriatic Arthritis
- Atopic dermatitis
- Ulcerative colitis
- Ankylosing spondylitis
- Crohn’s disease, and
- Radiographic seronegative spondyloarthritis
Because JAK inhibitors are very targeted therapies and potent immune modulators, their spectrum of coverage in autoimmune conditions is expanding.
Currently, it has resulted in favorable effects in patients with Vitiligo in a Phase 2 study.
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Rinvoq for Vitiligo?
The manufacturers of Rinvoq are investigating its use in conditions like non-segmental vitiligo.
They conducted a study where they compared its effects with a placebo, and the results were promising. [ref]
In a press release, AbbVie announced that they received positive results from a phase 2b clinical trial evaluating Rinvoq in adults with non-segmental vitiligo.
They found that in the 24th week, both 11 mg and 22 mg doses led to significant improvement in the Facial Vitiligo Area Scoring Index (F-VASI).
The press release also noted that more patients treated with Upadacitinib saw at least a 75% improvement in F-VASI and at least a 50% improvement in T-VASI compared to those who received the placebo at 52 weeks.
Phase 3 trials are soon to enroll patients. Until then, this drug is not approved for vitiligo by the FDA and is not recommended.
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FDA-Approved Drugs for Vitiligo:
While Rinvoq is still being studied for its effectiveness in the treatment of Vitiligo, there are a few options in the market that have received the FDA’s stamp of approval.
Topical Therapy for Vitiligo [Ref]:
Topical Corticosteroids:
Topical corticosteroids are frequently used to treat localized vitiligo especially when there is associated inflammation.
Topical corticosteroids, however, can cause skin atrophy and should be used with caution for a prolonged period of time.
In addition, when used over a larger surface area for a prolonged period of time, discontinuing them can cause adrenal insufficiency and adrenal crisis.
Opzelura (Ruxolitinib):
On July 19, 2022, the FDA approved this cream to treat the most common form of vitiligo, non-segmental vitiligo, in adults and children aged 12 or higher.
This is a topical Janus kinase inhibitor and was already approved for short-term and occasional chronic treatment of mild to moderate atopic dermatitis in non-immunocompromised patients aged 12 or higher (these patients were not responding well to other topical prescription therapies).
The first pharmacologic treatment for vitiligo patients’ repigmentation that has received FDA approval is this cream.
Opzelura is applied twice daily to affected areas, covering up to 10% of the body’s surface area. If the patient’s response is satisfactory, treatment with Opzelura may last longer than 24 weeks. [ref]
Calcineurin Inhibitors:
Topical Pimecrolimus is very effective, especially for vitiligo involving the scalp. It can be used in combination with topical corticosteroids, laser therapy, and ultraviolet light therapy.
These drugs are more effective when used in combination with topical corticosteroids and NB-UVB therapy.
Vitamin D analogs:
Calcipotriol and tacalcitol are two topical vitamin D analogs. Their use in patients with Vitilgo is not very clearly established.
However, combining Vitamin D analogs with topical corticosteroids or UVB light therapy may have additive effects.
Phototherapy for Vitiligo:
During this treatment, your affected skin is exposed to either ultraviolet A or B rays from a special lamp.
Before starting this therapy, you are asked to take a drug called psoralen. This can be taken by mouth or dissolved in bath water, and then you soak body parts in it, or it can be applied as a gel. [ref]
This sort of treatment is referred to as PUVA (psoralen and UVA light). It can raise the risks for skin cancer; however, the UVB light is less intense, so it is important to discuss every detail with your physician before initiating.
Due to the intensity of this therapy, it is only used if any topical treatment has not worked, the vitiligo is extremely bothersome to the patient, or if it is widespread.
Side effects of phototherapy for vitiligo may include skin erythema, pruritus, xerosis altered pigmentation, photoaging, and others.
If you are looking for phototherapy for vitiligo reviews, a meta-analysis found that narrowband UV-B phototherapy showed a lot of improvement in mild cases after 6 and 12 months, and there was even more improvement in severe cases over the same time in phototherapy for vitiligo results. [ref].
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Systemic Therapies for Vitiligo:
Afamelanotide:
Afamelanotide is an analog of alpha-melanocyte–stimulating hormone (α-MSH). It has a longer duration of action.
It has been approved by the FDA for the treatment of Vitiligo and preventing sunburns in patients with erythropoietic porphyrea.
It has been observed in clinical trials to have a rapid onset of action and works faster than most conventional therapies for vitiligo.
Oral JAK inhibitor (Tofacitinib):
Tofacitinib (Xeljanz) is one of the game-changers in the treatment of Vitiligo. It is associated with significant improvement.
Oral Prednisolone:
Oral prednisolone or twice-weekly methylprednisolone are used sometimes to treat resistant forms of vitiligo. However, because of the associated adverse effects of systemic corticosteroids, they are rarely used.
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Surgical Procedures for Vitiligo:
In extreme cases, a surgical treatment might be referred.
Skin grafting.
Due to how invasive this procedure can be, it is only done if no new depigmented patch has appeared in the last year, the vitiligo was not started by skin damage, like severe sunburn (Koebner response), and if said patches did not exacerbate during the previous year.
In this case, an unaffected skin patch is removed and used to replace the depigmented one.
An alternative to skin grafting is to take a sample of skin, extract the melanocytes, and transplant them to the vitiligo-affected areas.
Such procedures are not time efficient, can cause scar formation, and are not appropriate for pediatric patients.
Lastly, these are unavailable in most hospitals and are less commonly funded by the government.
The bottom line
Rinvoq is still not approved, which is why it can’t be used for vitiligo despite promising results from the phase 2b clinical trial of AbbVie.
However, if your condition is worsening day by day it is better to consult with your healthcare physician and explore therapies. Try any topical treatment before even thinking about any invasive procedure.
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