Turning the Tide on Vitiligo: Can JAK Inhibitors and Phototherapy Paint a New Future?

Original Article: Combination of Baricitinib and Phototherapy in Adults With Active Vitiligo: A Randomized Clinical Trial

What are the key takeaways of this article?

Vitiligo is a chronic autoimmune disorder characterized by skin depigmentation, which can often significantly impair one’s quality of life. A novel study by Seneschal et al. investigated a promising approach to treating severe, active vitiligo by combining narrowband ultraviolet B phototherapy with the oral Janus Kinase (JAK) inhibitor baricitinib. This double-blind randomized controlled trial enrolled 49 adult patients with extensive nonsegmental vitiligo affecting at least 5% of their body surface area. The participants were assigned in a 3:1 ratio to receive either 4 mg daily baricitinib or a daily placebo for 36 weeks, with both groups adding twice-weekly phototherapy after the initial 12 weeks.

After week 36, the results revealed compelling evidence for the efficacy of the combination therapy. The patients receiving baricitinib demonstrated a mean 44.8% improvement in repigmentation as measured by the Vitiligo Area Scoring Index (VASI), compared to 9.2% in the placebo group. As well, the authors reported that the treatment effects were particularly notable for facial lesions, with 56% of baricitinib-treated patients achieving ≥75% repigmentation, compared to only 9% in the placebo group. Post-hoc comparisons showed statistically significant improvements with combination therapy over phototherapy alone (p=0.02). Additionally, patient-reported outcomes were found to show greater reductions in disease burden and psychological impact among those receiving the combination therapy, suggesting quality-of-life improvements. The combination therapy exhibited a favorable safety profile, with adverse event rates comparable to the placebo group.

The findings from this article highlight important implications for future vitiligo management, suggesting that JAK inhibition could potentially enhance phototherapy outcomes and drive repigmentation. Limited by the modest sample size of the phase 2 trial, the results warrant larger phase 3 trials, which should explore optimal treatment durations and longer term safety profiles. With the dual impact of baricitinib-phototherapy combination therapy on autoimmune inflammation and melanocyte regeneration, this approach may potentially establish new standards of care for patients with treatment-resistant or severe vitiligo. This study marks a significant step forward in developing more effective, comprehensive therapies for vitiligo.

Publication Date: June 30, 2025

Reference: Seneschal J, Guyon M, Merhi R, et al. Combination of Baricitinib and Phototherapy in Adults With Active Vitiligo: A Randomized Clinical Trial. JAMA Dermatol. Published online January 22, 2025. doi:10.1001/jamadermatol.2024.5737

Summary By: Adam Bai