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Addition of Narrow-Band UVB Phototherapy to Ruxolitinib Cream in Patients With Vitiligo

      Vitiligo is a chronic autoimmune disease resulting in patches of skin depigmentation (
      • Taïeb A.
      • Picardo M.
      Clinical practice. Vitiligo.
      ) and reduced QOL (
      • Morrison B.
      • Burden-Teh E.
      • Batchelor J.M.
      • Mead E.
      • Grindlay D.
      • Ratib S.
      Quality of life in people with vitiligo: a systematic review and meta-analysis.
      ). Disease pathogenesis is driven by IFN-γ signaling through Jak1 and 2 (
      • Rashighi M.
      • Harris J.E.
      Interfering with the IFN-γ/CXCL10 pathway to develop new targeted treatments for vitiligo.
      ). Combination phototherapy with topical corticosteroids or topical calcineurin inhibitors has been shown to significantly improve repigmentation versus monotherapy in patients with vitiligo (
      • Batchelor J.M.
      • Thomas K.S.
      • Akram P.
      • Azad J.
      • Bewley A.
      • Chalmers J.R.
      • et al.
      Home-based narrowband UVB, topical corticosteroid or combination for children and adults with vitiligo: HI-light vitiligo three-arm RCT.
      ;
      • Dong Y.
      • Yang Q.
      • Guo B.
      • Zhu J.
      • Sun X.
      The effects of tacrolimus plus phototherapy in the treatment of vitiligo: a meta-analysis.
      ). Previous reports with Jak inhibitors have suggested additional therapeutic benefits with concomitant phototherapy (
      • Joshipura D.
      • Alomran A.
      • Zancanaro P.
      • Rosmarin D.
      Treatment of vitiligo with the topical Janus kinase inhibitor ruxolitinib: a 32-week open-label extension study with optional narrow-band ultraviolet B.
      ;
      • Liu L.Y.
      • Strassner J.P.
      • Refat M.A.
      • Harris J.E.
      • King B.A.
      Repigmentation in vitiligo using the Janus kinase inhibitor tofacitinib may require concomitant light exposure.
      ). In these patients, it has been proposed that Jak inhibition suppresses inflammatory signals that result in melanocyte destruction, leading to the potential recovery of melanocytes that may be enhanced during phototherapy-induced stimulation (
      • Liu L.Y.
      • Strassner J.P.
      • Refat M.A.
      • Harris J.E.
      • King B.A.
      Repigmentation in vitiligo using the Janus kinase inhibitor tofacitinib may require concomitant light exposure.
      ). Ruxolitinib is a Jak1/Jak2 inhibitor (
      • Quintás-Cardama A.
      • Vaddi K.
      • Liu P.
      • Manshouri T.
      • Li J.
      • Scherle P.A.
      • et al.
      Preclinical characterization of the selective JAK1/2 inhibitor INCB018424: therapeutic implications for the treatment of myeloproliferative neoplasms.
      ), and a topical formulation is in development for the treatment of vitiligo. In a phase 2, randomized, dose-ranging study in 157 adult patients with vitiligo (NCT03099304), ruxolitinib cream was associated with substantial repigmentation over 52 weeks and was well tolerated (
      • Rosmarin D.
      • Pandya A.G.
      • Lebwohl M.
      • Grimes P.
      • Hamzavi I.
      • Gottlieb A.B.
      • et al.
      Ruxolitinib cream for treatment of vitiligo: a randomised, controlled, phase 2 trial.
      ). In this study, we report the safety and efficacy of ruxolitinib cream with concomitant narrow-band UVB (NB-UVB) phototherapy during the open-label phase after week 52 of the phase 2 study.

      Abbreviations:

      BID (twice daily), F-VASI (facial Vitiligo Area Scoring Index), NB-UVB (narrow-band UVB), T-VASI (total body Vitiligo Area Scoring Index)
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