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Recent network meta-analyses identified the relative outcomes of various vitiligo monotherapies on vitiligo at 6 months.

Numerous therapies exist for vitiligo, and the effects have been investigated in a broad range of studies, yet evidence concerning the relative effects of vitiligo therapies is sparse. This led Aditya K. Gupta, MD, PhD, and colleagues to conduct network meta-analyses to identify the relative outcomes of various treatments. The researchers reported their findings in the Journal of Cosmetic Dermatology.

The authors identified 22 studies from peer-reviewed literature eligible for qualitative analyses. The studies were published in English and included an arm that investigated the effects of monotherapy on vitiligo at 6 months. The data were sufficient to analyze networks for UV-based phototherapies, Janus kinase (JAK) inhibitors, corticosteroids, calcineurin inhibitors, and minocycline.

Phototherapy

Regarding phototherapy, the analyses showed no significant efficacy difference among psoralen (oral) + UVA 3 times a week for 6 months, narrow band UVB (NB-UVB) 3 times a week for 6 months, and NB-UVB 2 times a week for 6 months in the probability of achieving repigmentation of 25% or more after 6 months.

JAK Inhibitors

The researchers observed no significant differences among JAK inhibitors based on the mean percentage reduction in the Vitiligo Area Scoring Index (VASI) at 6 months. However, upadacitinib, cyclosporine, ritlecitinib, and dexamethasone were significantly more effective than minocycline.

Oral upadacitinib (15-22 mg once daily for 6 months) was considerably more effective than placebo (mean difference, −14.29%; 95% CI, −24.32% to −4.34%; P<0.05) and oral minocycline (100 mg per day for 6 months; mean difference, −12.74%; 95% CI, −24.90% to −0.70%; P<0.05).

Topicals

Mometasone furoate 0.1% cream and topical tacrolimus 0.1% ointment were significantly more effective than topical tacrolimus 0.03% ointment for skin repigmentation at 6 months.

In addition, mean reductions in VASI at 6 months showed that ruxolitinib 1.5% cream once daily, ruxolitinib 0.5% cream once daily, and ruxolitinib 0.15% cream once daily for 6 months did not differ significantly in efficacy.

“Overall, the findings from this study provide valuable insights to inform the clinical care of vitiligo, highlighting key areas for improving patient management,” the authors concluded. “Moreover, the results underscore the need for large, multi-arm, randomized, controlled trials to validate these findings and explore comprehensive treatment strategies for vitiligo.”