A new study found that patients with nonsegmental vitiligo who took the oral drug ritlecitinib and also received narrowband ultraviolet phototherapy had greater improvements in skin repigmentation compared with those who took the drug alone.
In the study, researchers included 230 adult patients with active vitiligo. Among them, 187 received ritlecitinib alone and 43 of them received ritlecitinib plus narrowband ultraviolet phototherapy (nbUVB) therapy twice-weekly. All of the patients began with a 200-mg daily dose of ritlecitinib for 4 weeks, followed by 50 mg daily for 20 weeks.
The researchers used the Facial Vitiligo Area Scoring Index (F-VASI) and Total Vitiligo Area Scoring Index (T-VASI) to track changes in repigmentation. At week 24, facial scores improved by 69.6% in the combination group compared with 55.1% in the ritlecitinib alone group (observed case analysis). Total-body scores improved by 46.8% vs 24.5%, respectively.
A greater proportion of the patients in the combination group met key improvement thresholds. For instance, 60.9% achieved at least 75% improvement in facial repigmentation compared with 29.2% in the monotherapy group. For total-body repigmentation, 50% of combination therapy patients achieved 50% improvement compared with 15.2% receiving monotherapy.
“Significantly more patients receiving ritlecitinib [plus] nbUVB reported clinically meaningful improvement in their vitiligo compared with those receiving ritlecitinib monotherapy in the [observed case] analysis,” said lead study author Yuji Yamaguchi, MD, PhD, of Pfizer, and colleagues.
Patient-reported outcomes echoed these findings. In the combination group, 57.7% said they felt “much improved” or “very much improved” compared with 30.0% in the monotherapy group.
Both treatment types were generally well tolerated. Mild to moderate adverse events (AE) occurred in 74.4% of patients in the combination group and 63.6% in the ritlecitinib-only group. Common AEs included urinary tract infections, headaches, and photosensitivity. One serious AE occurred, unrelated to study treatment.
Nine patients in the combination group were withdrawn at week 12 because they had less than 10% improvement in T-VASI—a protocol requirement specific to that group.
Although the sample sizes were unequal and the analysis exploratory, the findings suggested that adding nbUVB to ritlecitinib may enhance repigmentation, particularly in areas not regularly exposed to sunlight.
The researchers noted that longer treatment periods may be needed to assess the full effects of combination therapy and recommended further studies to explore how the two treatments may work together.
Full author disclosures are available in the original publication.
