Ruxolitinib Repigments Many Vitiligo Affected Body Areas

Sara Freeman

October 03, 2022

Ruxolitinib (Opzelura) cream can help repigment the skin in many body areas affected with vitiligo, researchers reported at the European Academy of Dermatology and Venereology (EADV) 2022 Annual Meeting.

Those difficult areas include the hands and feet, said Thierry Passeron, MD, PhD, of Université Côte d'Azur and Centre Hospitalier Universitaire de Nice in France.

Indeed, a 50% or greater improvement in the Vitiligo Area Scoring Index (VASI-50) of the hands and feet was achieved with ruxolitinib cream in around one third of patients after 52 weeks' treatment, and more than half of patients showed improvement in the upper and lower extremities.

During one of the late-breaking news sessions, Passeron presented a pooled analysis of the Topical Ruxolitinib Evaluation in Vitiligo Study 1 (TRuE-V1) and Study 2 (TruE-V2), which assessed VASI-50 data by body regions.

Similarly positive results were seen on the head and neck and the trunk, with VASI-50 being reached in a respective 68% and 48% of patients after a full year of treatment.

"VASI-50 response rates rose steadily through 52 weeks for both the head and trunk," said Passeron. He noted that the trials were initially double-blinded for 24 weeks and that there was a further open-label extension phase through week 52.

In the latter phase, all patients were treated with ruxolitinib; those who originally received a vehicle agent as placebo crossed over to the active treatment.

First FDA-Approved Treatment for Adults and Adolescents With Vitiligo

Ruxolitinib is a Janus kinase 1/2 inhibitor that has been available for the treatment for atopic dermatitis for more than a year. It was recently approved by the US Food and Drug Administration for the treatment of vitiligo in adults and pediatric patients aged 12 years and older.

This approval was based on the positive findings of the TRuE-V1 and TRuE-V2 studies, which showed that after 24 weeks, 30% of patients treated with ruxolitinib had at least 75% improvement in the facial VASI, compared with 10% of placebo-treated patients.

"These studies demonstrated very nice results, especially on the face, which is the easiest part to repigment in vitiligo," Passeron said.

"We know that the location is very important when it comes to repigmentation of vitiligo," he added. He noted that other body areas, "the extremities, for example, are much more difficult."

The analysis he presented specifically assessed the effect of ruxolitinib cream on repigmentation in other areas.

Pooled Analysis Performed

Data from the two TRuE-V trials were pooled. The new analysis included a total of 661 individuals; of those patients, 443 had been treated with topical ruxolitinib, and 218 had received a vehicle cream as a placebo.

For the first 24 weeks, patients received twice-daily 1.5% ruxolitinib cream or vehicle cream. This was followed by a 28-week extension phase in which everyone was treated with ruxolitinib cream, after which there was a 30-day final follow-up period.

Passeron reported data by body region for weeks 12, 24, and 52, which showed an increasing percentage of patients with VASI-50.

"We didn't look at the face; that we know well, that is a very good result," he said.

The best results were seen for the head and neck. VASI-50 was reached by 28.3%, 45.3%, 68.1% of patients treated with ruxolitinib cream at weeks 12, 24 and 52, respectively. Corresponding rates for the placebo-crossover group were 19.8%, 23.8%, and 51%.

Repigmentation rates of the hand, upper extremities, trunk, lower extremities, and feet were about 9% to 15% for both ruxolitinib and placebo at 12 weeks, but by 24 weeks, there was a clear increase in repigmentation rates in the ruxolitinib group for all body areas.

The 24-week VASI-50 rates for hand repigmentation were 24.9% for ruxolitinib cream and 14.4% for placebo. Corresponding rates for upper extremity repigmentation were 33.2% and 8.2%; for the trunk, 26.4% and 12.2%; for the lower extremities, 29.5% and 12.2%; and for the feet, 18.5% and 12.5%.

"The results are quite poor at 12 weeks," Passeron said. "It's very important to keep this in mind; it takes time to repigment vitiligo, it takes to 6 to 24 months.

"We have to explain to our patients that they will have to wait to see the results."

Steady Improvements, No New Safety Concerns

Regarding VASI-50 over time, there was a steady increase in total body scores; 47.7% of patients who received ruxolitinib and 23.3% of placebo-treated patients hit this target at 52 weeks.

"And what is also very important to see is that we didn't reach the plateau," Passeron reported.

Similar patterns were seen for all the other body areas. Again there was a suggestion that rates may continue to rise with continued long-term treatment.

"About one third of the patients reached at least 50% repigmentation after 1 year of treatment in the hands and feet," Passeron said. He noted that certain areas, such as the back of the hand or tips of the fingers, may be unresponsive.

"So, we have to also to warn the patient that probably on these areas we have to combine it with other treatment because it remains very, very difficult to treat."

There were no new safety concerns regarding treatment-emergent adverse events, which were reported in 52% of patients who received ruxolitinib and in 36% of placebo-treated patients.

The most common adverse reactions included COVID-19 (6.1% vs. 3.1%), acne at the application site (5.3% vs 1.3%), and pruritis at the application site (3.9% vs 2.7%), although cases were "mild or moderate," said Passeron.

An Expert's Take-Home

"The results of TRuE-V phase 3 studies are encouraging and exciting," Viktoria Eleftheriadou, MD, MRCP(UK), SCE(Derm), PhD, said in providing an independent comment for Medscape Medical News.

"Although ruxolitinib cream is applied on the skin, this novel treatment for vitiligo is not without risks; therefore, careful monitoring of patients who are started on this topical treatment would be prudent," said Eleftheriadou, who is a consultant dermatologist for Walsall Healthcare NHS Trust and the Royal Wolverhampton NHS Trust in Birmingham, United Kingdom.

"I would like to see how many patients achieved VASI-75 or VASI-80 score, which from patients' perspectives is a more meaningful outcome, as well as how long these results will last for," she added.

The study was funded by Incyte Corporation. Passeron has received grants, honoraria, or both from AbbVie, ACM Pharma, Almirall, Amgen, Astellas, Bristol-Myers Squibb, Celgene, Galderma, Genzyme/Sanofi, GlaxoSmithKline, Incyte Corporation, Janssen, LEO Pharma, Eli Lilly, Novartis, Pfizer, Sun Pharmaceuticals, and UCB. Passeron is the cofounder of YUKIN Therapeutics and has patents on WNT agonists or GSK2b antagonist for repigmentation of vitiligo and on the use of CXCR3B blockers in vitiligo. Eleftheriadou is an investigator and trial development group member on the HI-Light Vitiligo Trial (specific), a lead investigator on the pilot HI-Light Vitiligo Trial, and a medical advisory panel member of the Vitiligo Society UK. Eleftheriadou also provides consultancy services to Incyte and Pfizer.

European Academy of Dermatology and Venereology (EADV) 2022 Annual Meeting: Late-breaking oral presentation 3640. Presented September 10, 2022.

Sara Freeman is a freelance journalist based in London, England.

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