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Tofacitinib: A Potential New Treatment for Vitiligo
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.
- See more at: http://www.jwatch.org/na38397/2015/07/24/tofacitinib-potential-new-treatment-vitiligo#sthash.sCarDD96.dpuf
COMMENT
Tofacitinib is being evaluated by dermatologists for psoriasis because it blocks steps in the interleukin-17 (IL-17) signal transduction pathway. But the same Jak1/Stat signal transduction pathway employed by IL-17 is used by many other immunologically active cytokines (e.g., IL-12, IL-23, IL-22, IL-6, IFN-γ, and type I interferons). This suggests that tofacitinib may be effective for many other inflammatory skin diseases with unsatisfactory treatment options. For example, tofacitinib may be effective for alopecia universalis (NEJM JW Dermatol Mar 1 2015 and J Invest Dermatol 2014 Dec).
Now these authors suggest that it may be helpful in vitiligo as well. It is difficult to conclude much about the safety and efficacy of tofacitinib based on one patient, but the results are intriguing, the theoretical basis is sound, and the need is sufficient to explore this option further.