Tofacitinib: A Potential New Treatment for Vitiligo

Craig A. Elmets, MD reviewing Craiglow BG and King BA. JAMA Dermatol 2015 Jun 24.

The results are intriguing, the theoretical basis is sound, and the need is sufficient to explore this option further.

Recent experimental studies have found that interferon γ (IFN-γ) plays an important role in the pathogenesis of vitiligo by stimulating the synthesis and release of CXCL10. When IFN-γ binds to its receptor, it activates the Jak/Stat pathway, which in turn results in production of CXCL10. Tofacitinib, a small molecule inhibitor of Jak1/3 is FDA approved for rheumatoid arthritis has shown efficacy for psoriasis in phase 3 clinical trials (NEJM JW Dermatol Jul 1 2015 and Lancet 2015 Jun 5).

Because of the possible role of the Jak/Stat pathway in vitiligo, dermatologists administered tofacitinib to a patient with rapidly progressive vitiligo who had failed or was intolerant of other forms of therapy, including topical steroids, topical tacrolimus, and narrowband UVB phototherapy. Tofacitinib was initiated at 5 mg every other day, increasing to 5 mg daily after 3 weeks. (For comparison purposes, the recommended dose for rheumatoid arthritis is 5 mg twice a day.) Repigmentation was apparent within 2 months, and by 5 months, the face and hands had complete repigmentation. The patient ultimately had nearly 95% repigmentation.

Citation(s):

Craiglow BG and King BA.Tofacitinib citrate for the treatment of vitiligo: A pathogenesis-directed therapy. JAMA Dermatol 2015 Jun 24; [e-pub].