Iltefat Hamzavi, MD: Long-Term Implications of New Data on Upadacitinib for Nonsegmental Vitiligo

Newly-released phase 2b data on daily upadacitinib monotherapy for adults with extensive non-segmental vitiligo (NSV) were presented at the 2024 American Academy of Dermatology (AAD) Annual Meeting.

These data indicated that the treatment resulted in clinically-meaningful re-pigmentation for the vitiligo patients, assessed through patients’ facial (F)-VASI and total (T)-VASI. There had been 185 participants given once-daily upadacitinib 20 mg, 11 mg, 6 mg, or placebo.

Iltefat Hamzavi, MD, senior staff physician at Henry Ford Health System's department of dermatology and founding co-chair of the Global Vitiligo Foundation, spoke with HCPLive about his team’s late-breaking data. In a new segment of his interview, Hamzavi was asked about the next steps for research and development in the field of upadacitinib for non-segmental vitiligo, based on their findings.

“As always, you want to add more patients to the study,” Hamzavi said. “Because we don't have enough in this particular study. We also want to make sure that we have that subgroup analysis to figure out where the sweet spots are. Duration (is important), as we talked about, if we can go a little bit longer than the 52 weeks and have an extension.”

Another element Hamzavi highlighted is that future investigations should look at the speed of the response. Patients taking medication and showing their first response at 6 months is not a reaction that most people are comfortable with.

“So can we accelerate response?” Hamzavi explained. “Phototherapy is our easiest, most accessible option to provide melanocyte migration, really managing the immunology with this medication. In all the other studies that are going on, when you add phototherapy with a significant high response, the dropout rate is also affected. So can we make this faster by adding phototherapy? Can we add agents that will stimulate melanocytes that are also coming to various studies, agents that stimulate melanocytes, stimulation hormones or analogues, and then combining that.”

Hamzavi noted that investigators are finally getting to a point at which there is a significant difference between placebo control.

“The study does show that you can go to a higher dose and then it plateaus,” Hamzavi said. “We found that out, but now can we make it go faster and still remain safe? So far, the safety and efficacy endpoints are showing that there are not too many concerns, but a safety signal sometimes takes a lot more patients. And this medication will probably have to be taken by patients for a long period of time.”

Hamzavi expressed the apparent necessity of long term safety data on this medication and the value of ensuring that patients understand what they may be doing.

"So if we can have a level of precision, if we can figure out how to help make it go faster,” Hamzavi added. “If we can have a level of confidence that it's safe in this population group, that I think will really advance the field but we still have a lot of work to do.”

For any additional information on the topic, view Hamzavi’s full interview segment above or the previous interview segment.

The quotes contained in this description were edited for clarity.