Upadacitinib Combined with NB-UVB for Non-Segmental Vitiligo: A Single-Center Prospective Study

BACKGROUND: Vitiligo is a chronic autoimmune depigmenting disorder with limited therapeutic options for patients with active and refractory disease. Janus kinase (JAK) inhibitors have emerged as promising treatments, and combination therapy with phototherapy may further enhance repigmentation. OBJECTIVES: To evaluate the efficacy and safety of oral upadacitinib combined with narrowband ultraviolet B (NB-UVB) phototherapy in patients with active non-segmental vitiligo. METHODS: In this prospective cohort study, adults with active non-segmental vitiligo and inadequate response to prior therapies received either oral upadacitinib (15 mg once daily) combined with NB-UVB phototherapy or NB-UVB alone for 12 weeks. The primary endpoint was achievement of ≥50% improvement in total Vitiligo Area Scoring Index (T-VASI50) at week 12. Secondary endpoints included changes in T-VASI, facial VASI (F-VASI), Vitiligo Extent Score (VES), and disease activity and improvement scores (VDAS/VDIS). Safety was assessed throughout the study. RESULTS: A total of 38 patients were included, with 19 patients in each treatment group. At week 12, 47.4% of patients in the combination group achieved T-VASI50, compared with 5.3% in the NB-UVB monotherapy group (P = 0.0078). The combination group showed significantly greater mean percentage improvements in T-VASI (49.1%±20.3% vs 18.7%±14.3%, P < 0.01) and VES (44.6%±20.1% vs 18.6%±13.8%, P < 0.01). Superior responses were observed in truncal and non-acral extremity lesions, whereas facial outcomes did not differ significantly between groups. All adverse events were mild, and no serious adverse events were reported. CONCLUSIONS: Oral upadacitinib combined with NB-UVB phototherapy demonstrated superior short-term efficacy compared with NB-UVB alone in patients with active non-segmental vitiligo, with an acceptable safety profile. These findings support this combination as a promising therapeutic strategy and warrant further validation in larger randomized controlled trials with longer follow-up.