Restoring Skin Pigmentation in Vitiligo With Advanced Treatments - Episode 11

Treatment Response to Conventional vs Emerging Therapies in Vitiligo

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Nada Elbuluk, MD, and Ted Lain, MD, compare response to conventional treatment options vs emerging therapies, such as ruxolitinib, in the treatment of vitiligo.

Seemal Desai, MD: Nada, I’m going to ask you a question about stability and relapse, because you also talked about the need for long-term treatment and conventional therapies. We see relapse rates. We see patients who have committed time and money, the co-pays for phototherapy. They’re with you, they’re focused, they’re there for a year and they get better; and then 3 months after stopping some therapy, they start getting worse again. So, what are your thoughts about relapse rates with conventional treatments vs ruxolitinib?

Nada Elbuluk, MD: We don’t have long-term data past 52 weeks right now to really know what the relapse rates are going to be. I think we will have that over time. So, I can’t really say at this point if the relapse rate is better or worse with ruxolitinib. We’ll just have to see. But we know that vitiligo is a chronic disease. We don’t have a cure. We know there’s genetic predisposition to it, and it can wax and wane, and you can get triggers. I’ve had patients who…repigment, and stabilize, and stay like that for years, and then I have other patients who, months after they repigment, start depigmenting again. It’s dependent on so many factors, and so many things can trigger it for people. We just have to, on a case-by-case basis, evaluate our patients and their needs, and their whole health overall. They can get sick or get COVID-19. That was the recent thing we saw in the last few years, and those kinds of things can flare their vitiligo. I think we’ll just have to see with ruxolitinib where it lands.

Seemal Desai, MD.: Wait for more data to come out. I think you’re on the complete right course there because there are new therapies and new studies coming. Ted, talk to us a little bit about some of those new things on the horizon. We’ve got something new already, but there’s a lot coming.

Ted Lain, MD: There is a lot coming. And, briefly, we can put them into buckets. We have the systemic JAK [Janus kinase] inhibitors, which are all showing some nice results. Some are a little bit better than others, as you would expect. They’re not equal. Then you’re looking at other targets within that type 1 interferon pathway. You’re looking at T-regulatory cells, miRNA [microRNA], for example. There’s a new one that’s about to go into a phase 2 trial called a DHODH [dihydroorotate dehydrogenase] inhibitor. Luckily, the industry is now paying attention to vitiligo. I think we’ve all been beating on the door to try to get some attention, and now we have that. Thank you, ruxolitinib cream, for opening the door for other therapies to come through. So, I think you’re going to see a multitude of targets and different therapeutic options for each one.

Seemal Desai, MD: And the oral JAKs, I definitely think there are some that are in phase 2 and phase 3. Many of us are involved in some of those studies and there are early promising results. So, I tell my patients, yes, we finally have something new. Kind of like Heather said, you smile and all these years, you couldn’t say much. Now you can say, we’ve got something, and there’s more on the horizon. So, I think, hope, hope, hope is such an important message for vitiligo right now.

Transcript edited for clarity