Ruxolitinib Cream: New Hope for Vitiligo?

Vitiligo is a skin disease caused by the progressive loss of melanocytes, which generates an important psychosocial impact on its patients. Immune factors such as CD8+ T-cell activation, interferon-gamma (IFN-γ) secretion and chemokines via the JAK/STAT pathway are involved in the apoptosis of these cells.

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Current reviews

Recent studies demonstrated the central role of the JAK/STAT pathway in vitiligo, with increased expression of JAK1 and JAK3 in the achromatic and motile regions. treatment with IJAK . inhibitorsincluding ruxolitinib, baricitinib, and tofacitinib. Based on a Phase 3 clinical trial evaluating the safety and effectiveness of ruxolitinib 1.5% cream (Opzelura), the U.S. Food and Drug Administration has approved its use for the treatment of non-segmental vitiligo in adult and pediatric patients 12 years of age or older.

Ruxolitinib is a selective inhibitor JAK1 and JAK2. Its oral formulation was approved in 2011 for the treatment of polycythemia vera, essential thrombocythemia and myelofibrosis. Although the drug has also been shown to be effective in inflammatory skin conditions such as alopecia areata, topical use of the cream has resulted in higher concentrations in the epidermis and dermis, with minimal systemic side effects. Thus, studies have investigated its effectiveness in inflammatory skin conditions such as vitiligo, alopecia areata, atopic dermatitis, lichen planus, and psoriasis.

consequences

In the treatment of vitiligo, ruxolitinib cream was able to produce clinically significant re-pigmentation of all areas of the body, including the acral areas, which are difficult to re-pigment. Concomitant UVB phototherapy appears to improve the drug’s efficacy. Overall, a concentration of 1.5% twice daily, on the face and/or body, resulted in clinical improvement after 6 months, with improvement sustained up to approximately 1 year.

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Topical administration of the drug allows for better delivery, rapid onset of action, and avoidance of the dreaded side effects of oral JAK inhibitors such as serious infections, heart problems and thrombosis. In the case of topical medications, the most common side effects were localized acne, erythema, pruritus, nasopharyngitis, headache, and fever. It is not recommended for use in cases of infection, hypersensitivity to any component of the preparation, uncontrolled heart disease and pregnancy. More studies are still needed to determine the optimal dose, efficacy, and long-term safety.

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