Amit Pandya, MD: Ruxolitinib Cream in Real-World Vitiligo Patients of Color

The US Food and Drug Administration (FDA) approved ruxolitinib cream (Opzelura) for the treatment of repigmentation in patients with vitiligo aged ≥12 years old last July.¹

The first of-its-kind topical therapy was associated with pivotal clinical data from the TRuE-V program showing significant repigmentation of patients’ skin in highly impacted areas including the face at 1 year. Further data from the TRuE-V extension trials presented at the American Academy of Dermatology (AAD) 2023 Annual Meeting showed maintained repigmentation in both patients who continued or withdrew from therapy after 1 year.²

Nearing the anniversary of the topical Janus kinase (JAK) inhibitor approval, clinicians may consider how ruxolitinib cream is faring in real-world patients relative to the pivotal trial data.

In an interview with HCPLive during the Maui Derm 2023 NP + PA Summer Conference in Colorado Springs this week, Amit Pandya, MD, director of the Clinic for Pigmentory Disorders at Palo Alto Medical Foundation and adjunct professor at the University of Texas Southwestern Medical Center, reviewed the impact of ruxolitinib cream in vitiligo patients with skin of color—a uniquely burdened subpopulation that may have altogether different treatment goals from light-skinned patients. Overall, the JAK inhibitor has benefitted patients with either skin complexion, Pandya said.

“Of course, in patients with skin of color, their vitiligo is a lot more noticeable to the public, especially on the face and hands,” Pandya said. “And ruxolitinib has shown unique ability to bring back the color on the face compared to the rest of the body. These (outcomes) are really important to patients of color, so I think they’ve been really pleased with the results.”

Pandya explained that lighter-skinned patients with vitiligo often have less noticeable pigmentation; their primary concern is often exacerbation of disease or more clearly distinct pigmentation due to sun exposure or phototherapy. Patients with skin of color with vitiligo have more difficulties concealing their pigmentation disorder.

“In skin-of-color patients, they may be more prone to accepting phototherapy because for them, the vitiligo is always noticeable,” Pandya said. “But when it comes to the use of ruxolitinib cream, I think both types of patients…like to have the cream because then what that does, is bring back new pigmentation in the areas of vitiligo.”

Interestingly, lighter-skinned patients who achieve new pigmentation may observe it’s a darker tone than their overall skin complexion; patients with skin of color do not report such an issue with ruxolitinib cream as frequently.

Regarding long-term benefit of ruxolitinib cream, Pandya noted that real-world patients who do experience repigmentation after 1 year may need to practice patience: many in the latest TRuE-V trial who achieved repigmenation in year 2 of treatment did not report such benefit previously.

“That’s because when you treat vitiligo with something like ruxolitniib or anything to remove the immune system’s attack to the skin, the white spots are still there. But now it requires some sun exposure, phototherapy, to slowly repigment,” Pandya said. “And that takes time—melanocytes can only migrate at a certain rate.”

Pandya was an investigator in Incyte’s pivotal trials for ruxolitinib cream in the treatment of patients with vitiligo.

References

1. ^{Butera A. FDA Approves Ruxolitinib Cream 1.5% for Nonsegmental Vitiligo. HCPLive. Published July 18, 2022. https://www.hcplive.com/view/fda-approves-ruxolitinib-cream-for-nonsegmental-vitiligo}
2. ^{Kunzmann K. Ruxolitinib Cream Maintains Vitiligo Facial Repigmentation At 2 Years. HCPLive. Published May 18, 2023. https://www.hcplive.com/view/ruxolitinib-cream-maintains-vitiligo-facial-repigmentation-2-years}