Alzahra A Mohammed, Anna S Lengyel, Fanni A Meznerics, István Szondy, Anna Walter, Bence Szabó, Dorottya Pál, Adrienn Bojtor, András Bánvölgyi, Norbert Kiss, Péter Hegyi, Lajos V Kemény, Zsuzsanna Kurgyis
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引用次数: 0
Abstract
Introduction: Vitiligo, a chronic skin disease affecting 1-2% of the global population, is associated with significant impairment in quality of life. Current pharmacological treatment options have limited efficacy and considerable side effects. Recent studies have shown promising results when using Janus kinase inhibitors (JAKis). Despite these favourable findings, there remains a critical need for comprehensive data on the efficacy and safety of JAKi in the treatment of vitiligo.
Methods: Three databases were searched for studies on patients with vitiligo treated with oral or topical JAKi, with or without conventional therapy. Placebo or vehicle cream were comparators in randomised controlled trials (RCTs). Outcomes included a 75% improvement in Facial-Vitiligo Area Scoring Index (F-VASI), mean Vitiligo Area Scoring Index (VASI) improvement, repigmentation percentage and adverse events. We performed three analyses: one using RCT data, one from case reports and a novel cohort of JAKi-treated patients from case reports. The protocol is registered with PROSPERO (CRD42023445503).
Results: Among the 35 articles identified, 19 were included in the statistical analyses. A meta-analysis of three randomised controlled trials (RCTs) on topical Janus kinase inhibitors (JAKis) suggested that patients treated with JAKi were more likely to achieve Facial Vitiligo Area Scoring Index 75 (F-VASI75) than those using vehicle cream (risk ratio (RR) 3.47, 95% confidence interval (CI) 0.98-12.22), with no significant difference in adverse events between groups (RR 1.27; 95% CI 0.88-1.82). A meta-analysis of four single-arm trials showed a 43.8% mean Vitiligo Area Scoring Index (VASI) improvement (95% CI 0.71-0.93). A cohort (n = 28) from case reports and series revealed significant repigmentation increases of 48.7% and 63.7% (p = 0.0018; p < 0.001) in patients treated with JAKi alone or with narrowband ultraviolet B (UVB). However, data were insufficient to determine if combination treatments were superior to JAKi alone.
Conclusion: Our systematic review evaluated the efficacy and safety of JAKi for vitiligo using data from RCTs, single-arm trials and case reports. While topical ruxolitinib showed promising but non-significant results in RCTs, single-arm trials and case studies highlighted significant repigmentation, particularly with oral JAKis combined with other therapies. Oral JAKis showed effectiveness but require caution due to potential adverse effects such as immune suppression and cardiovascular risks. Furthermore, it is important to acknowledge that a considerable proportion of patients do not respond to these therapies. Additional RCTs are needed to address long-term safety, optimise application strategies and establish standardised endpoints for combination therapies.
期刊介绍:
Dermatology and Therapy is an international, open access, peer-reviewed, rapid publication journal (peer review in 2 weeks, published 3–4 weeks from acceptance). The journal is dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of dermatological therapies. Studies relating to diagnosis, pharmacoeconomics, public health and epidemiology, quality of life, and patient care, management, and education are also encouraged.
Areas of focus include, but are not limited to all clinical aspects of dermatology, such as skin pharmacology; skin development and aging; prevention, diagnosis, and management of skin disorders and melanomas; research into dermal structures and pathology; and all areas of aesthetic dermatology, including skin maintenance, dermatological surgery, and lasers.
The journal is of interest to a broad audience of pharmaceutical and healthcare professionals and publishes original research, reviews, case reports/case series, trial protocols, and short communications. Dermatology and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an International and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of quality research, which may be considered of insufficient interest by other journals. The journal appeals to a global audience and receives submissions from all over the world.