Efficacy of Janus kinase inhibitor combined with phototherapy in non-segmental vitiligo: systematic review and meta-analysis

TL;DR

Combining JAK inhibitors with phototherapy significantly improves skin repigmentation in non-segmental vitiligo compared to phototherapy alone.

Contribution

Demonstrates the added efficacy of JAK inhibitors when combined with NB-UVB phototherapy for non-segmental vitiligo.

Findings

Combination therapy reduced total VASI significantly compared to controls.

Patients were more likely to achieve ≥50% and ≥75% repigmentation with the combination therapy.

Significant improvements were observed in multiple body regions after sensitivity analysis.

Abstract

Vitiligo is a chronic autoimmune disease causing skin depigmentation and psychosocial issues. Non-segmental vitiligo often shows limited response to standard therapies. The IFN-γ–JAK–STAT pathway plays a key role, and combining JAK inhibitors with NB-UVB may improve repigmentation.

To evaluate the efficacy of JAK inhibitors (baricitinib or tofacitinib) plus NB-UVB versus NB-UVB without JAK inhibitors in adult NSV.

PubMed, Cochrane, and ClinicalTrials.gov were searched till August 2024 for randomized controlled trials. Four studies, comprising 217 adults (121 in the combination group and 96 in the control group), were analyzed using RevMan 5.4. Bias was assessed via Newcastle-Ottawa, Cochrane ROB-2, and ROBINS-I tools.

Combination therapy significantly reduced total VASI compared to controls (MD = −4.96, 95% CI [–9.29, −0.63], p = 0.02), with a greater effect on sensitivity analysis (MD = −6.84, p = 0.0007). Significant reductions were seen in face/neck (MD = −0.17, p = 0.002), trunk (MD = −3.62, p = 0.0001); acral (MD = −0.85, p = 0.0002) and extremity (MD = −4.61, p < 0.00001) regions after sensitivity analysis. Patients were more likely to achieve ≥50% (RR = 6.87, p < 0.00001) and ≥75% (RR = 15.13, p = 0.006) repigmentation.

JAK inhibitor plus NB-UVB markedly improves the repigmentation in adult NSV compared to NB-UVB alone.

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