Combination Therapy with Baricitinib and Narrowband Ultraviolet B for Active Non-Segmental Vitiligo: A Retrospective Controlled Study

Background: Vitiligo is a chronic autoimmune disease manifested by depigmented patches of skin devoid of melanocytes. Baricitinib, a JAK inhibitor selectively targeting JAK1/2, has shown preliminary efficacy for vitiligo. We aimed to assess the efficacy and tolerability of combination therapy with baricitinib and narrowband UV-B (NB-UVB) to treat active nonsegmental vitiligo (NSV). Methods: We formed a combination group of 52 patients with NSV receiving baricitinib and NB-UVB irradiation, and a control group of 49 patients with NSV receiving oral mini-pulse (OMP) methylprednisolone and NB-UVB irradiation. Efficacy analysis was conducted for the 6-month period. Six months after the last treatment, the recurrence rates were investigated through follow-up. Results: From the first month, the mean total vitiligo area scoring index (VASI) score was significantly reduced in the combination group when compared to that in the control group. Starting on the fourth month, the overall response rates (ORRs) were significantly higher in the combination group than in the control group ( P =0.034). By the sixth month, the ORRs reached 86.5% in the combination group, whereas they reached 67.3% in the control group ( P =0.022). The serum levels of IFN-γ and CXCL10 in the combination group decreased from 38.52± 5.98 pg/mL and 976.67± 150.57 pg/mL at baseline to 26.46± 5.93 pg/mL and 704.14± 103.38 pg/mL at the 6-month juncture, respectively ( P < 0.001). Moreover, we found that there was no significant difference in recurrence rates within 6 months after stopping treatment in both groups. Three patients (5.8%) in the combination group reported developing itchy skin during the first month of treatment period, and one patient (1.9%) developed erythema; no other serious adverse events occurred. Conclusion: Our observations suggest that the combination therapy with baricitinib and NB-UVB is a promising strategy against NSV. Patients tolerated the treatment well without serious AEs, these results expand treatment options for vitiligo patients, warranting larger clinical trials. Keywords: autoimmune disease, re-pigmentation, efficacy, assessment, safety