As most vitiligo patients know by now, a few years ago there was super-exciting news that an existing drug, which is currently FDA-approved for rheumatoid arthritis, reversed vitiligo in some patients. This was so exciting that it was all over the news and not just in the vitiligo community. Even if the drug was not specifically made for treating vitiligo, one patient who was taking it for rheumatoid arthritis found her vitiligo was repigmenting. After this happened, some vitiligo patients started using the drug and repigmented as well. This drug is called Xeljanz (tofacitinib), and as exciting as this may sound, there are negative aspects to it too. The first one is the fact that it shuts down a lot more of your immune system than needed. In fact, it proved to cure more than just rheumatoid arthritis and vitiligo. Some patients with alopecia using this drug found their hair to have magically re-grown. For this reason, Xeljanz is now undergoing a clinical trial to study its potential to treat alopecia areata, and at the time of writing this article, just a few weeks ago it was reported it successfully passed phase two clinical trial! This means it’s very likely that Xeljanz will be FDA-approved for the treatment of alopecia as well. Now, the fact that it suppresses a lot of the immune system has obvious side effects. A few people reported getting the flu or cold very easily, even people who normally never get sick. A woman also reported getting toe fungus and caught every single illness her daughter was catching at school. However, everyone repigmented successfully, although I haven’t read of anyone fully repigmenting the fingers, which are difficult areas to repigment with any current treatment. The real issue is that there are rare side effects which can be very serious, especially in elderly people or people who aren’t healthy. The second downside is the cost: at the time of writing, the price for the supply for one year of use is 50,000 US dollars in the US, or 15,000 dollars in Canada.
Shortly after the discovery that Xeljanz was effective in treating vitiligo, another JAK inhibitor was found to reverse vitiligo. It was then tested on a patient and proved effective in reversing vitiligo within a few months without any other treatment nor light therapy. This drug is called Jakafi, and its original purpose is treating myelofibrosis. It does have fewer side effects than Xenjalz, but the costs are pretty insane. I believe we are talking about 6,000 dollars or more for just one month of treatment. In order to prove the efficiency of these drugs in the treatment of vitiligo, larger clinical trials would be needed. However, it is now widely accepted that JAK inhibitors are very effective in reversing vitiligo because many people used them for this purpose and reported to have repigmented. More clinical trials on this will never happen though, as more specific pathways of the immune system attacking melanocytes have been found, and a more targeted drug to treat vitiligo has already been developed. Therefore it would not make sense to test JAK inhibitors on vitiligo on a large scale when we already have a much better drug which is being tested already. Having said that, JAK inhibitors have been created in topical form, and applying them as cream greatly reduces side effects.
The JAK inhibitor cream, topical ruxolitinib, is already in phase two of clinical trials! In early tests, the cream repigmented almost 100% of the face in a patient in about six months with the help of UVB light therapy. Unfortunately, it hasn’t proven very effective on the hands, but remains very effective on the face, according to preliminary tests. Again, the topical form will be much safer than the pill, and it won’t be nearly as expensive. The clinical trial is already in progress and it will last for two years. However, even if the cream is not marketed yet, it can already be compounded by a pharmacy, but right now the cost of doing so is 1,500 US dollars for just a 30g tube. Once marketed, though, it will be much more affordable for everyone. It’s very likely that, within a few years, topical JAK inhibitors will become the new standard creams for treating vitiligo.
Update: in the article we said there would not be clinical trials involving oral jak inhibitors for the treatment of vitiligo, it now appears there are two clinical trials about Xeljanz in the tretment of vitiligo. We will keep you updated!