Vitiligo in ten years will be a thing of the past

As a Star Trek fan, now that I have vitiligo I imagine being part of the crew of the starship federation Voyager where the holographic doctor would simply give me a shot of the hypospray and… done! my vitiligo would be completely cured! waking up with that strange white patch would be something I would probably forget before the end of the day, and never think about it again. To dream about this though we don’t need to go as far as 400 years in the future. The vitiligo research is going through a big revolution and it’s happening right now: there are dozens of clinical trials (and counting) going on for the treatment of vitiligo, which is a bigger number than ever before, in fact the vitiligo research has made more progress in the past 10 years alone than in the past 2000. Let’s see how all this evolved. Until a few years ago scientists didn’t even know what was causing vitiligo: at first, autoimmunity was only one of many theories, then they proved that vitiligo is indeed an autoimmune disease with absolute certainty and, finally,  we recently even discovered the actual pathway of immune system responsible for vitiligo, and this, my friends, was really huge. More specifically, in my opinion the biggest breakthrough ever so far was the discovery that cytokine CXCL10 is the one responsible for vitiligo.
This means we now know exactly what to target and  researchers no longer have to guess, and this is the reason why clinical trials from now on are extremely likely to be successful where they had failed in the past. For this reason pharmaceutical companies are a lot more inclined to invest in vitiligo because (due to these new discoveries) from now on new drugs  will have a much higher chance of succeeding, this makes investing in vitiligo a much safer bet than it used to be. This is why some drugs have already been developed! unfortunately clinical trials take a long time so they are not available on the market just yet, but some of these drugs being tested are proving extremely effective and they are very promising. In this post I will not list them all but I will mostly write about my two favorite ones: one is the famous antibody blockade of il-15 we are all excited about. If you are a vitiligo patient this is likely old news for you: this drug will not only lead to rapid repigmentation, but it will remove the resident memory cells from the white patches so after repigmenting you will be able to live vitiligo free potentially for many years without taking the drug. I won’t go into any more details because we already wrote an article just for the antibody blockade of il-15, click here if you would like to read it.  My second favorite future treatment for vitiligo is potentially more targeted and even more efficient: in 2013 a very important discovery made headlines in international news: scientists found that mutating protein HSP70i reverses vitiligo! you can read many old articles from 2013 when this discovery was announced, here is one of them:

This article is old, but this research took off and it’s still in progress and more promising than ever. In fact, here is a much more recent and updated article about it:
Unfortunately DNA delivery of a mutant protein in the skin takes a long time to develop so it’s estimated that it could take another eight years before anything based on this is on the market and available for patients to use.
Then there is another drug, AMG 714 is for celiac disease and the reason we like it is because it’s a il-15 inhibitor, which means that it’s extremely likely it will treat vitiligo too, and the exciting part is that this drug already passed phase 2 clinical trials for celiac disease so it will be available even sooner, yes it will be off label and as a new drug it will be expensive, but it’s good to have yet another option which will be on the market fairly soon. If you want to know more, we also wrote about AMG 714 here.
Among the several countless upcoming drugs are Topical ruxolitinib (a few days ago they actually just announced the results of phase 2 clinical trials), a CO2 laser has been tested for vitiligo for many years now and it seems to be somewhat effective even on the hands,  and the list goes on and on.
Not only we have all these promising upcoming treatments, we even found that drugs already on the market works in reversing vitiligo: I am talking about the Jak inhibitors, probably the most known one is tofacitinib (or Xeljanz), at the time of writing this post there are currently three clinical trials about Xeljanz for the treatment of Vitiligo, but since many people are already using it off label (it’s already on the market but currently FDA approved for the treatment of rheumatoid arthritis), we already pretty much know it works, except not too well on hands and feet unfortunately.  Researchers think this will be the first FDA approved drug to reverse vitiligo. You can see a short interview with Dr Harris where he talks about this here. This treatment is not ideal though as Xeljanz is a powerful immunosuppressant and it inhibits much more immune system than you would need to shut down for only treating  vitiligo, in fact this treats a variety of autoimmune diseases like rheumatoid arthritis and alopecia.  This translates in potential side effects like infections which could be serious ones in rare cases, especially in patients who are not healthy or who are taking other immunosuppressors. Personally I have talked to a few vitiligo patients who have been using Xeljanz successfully and without experiencing any issues. In spite of the potential side effects (and the costs, until it’s fda approved for vitiligo) the fact that a drug already on the market can reverse vitiligo is exciting and this was actually one of the factors which helped researchers to understand more about vitiligo.

Some people who have had vitiligo for  decades are very skeptical about these upcoming treatments because, as mentioned, in the past there have been a few clinical trials which proved unsuccessful, two major examples are Atrovastatin and Simvastatin, both of them proved to work in mice, but small clinical trials on humans (only a handful of patients) didn’t report statistically significant improvements and it was thought that in order to make them work they would have to increase the dosage to unnsafe levels for humans, so those clinical trials were discontinued. Because of this and other failures some people got used to initial promising therapies which turn into nothing and they are now inclined to think that not too much is being done in the vitiligo research, or that current clinical trials are just like the old ones: a false hope. But as mentioned there is now a huge difference, there is a new sheriff in town and it’s called CXCL10. As mentioned, we know that inhibiting this cytokine leads to repigmentation, and this isn’t a theory, it’s a proven fact and it is, at the time of writing this post, probably the most important discovery in the vitiligo research up to date. In the past, some drugs which inhibits CXCL10 were being developed and they were being tested on other autoimmune diseases like Chron’s, but they didn’t work on those other autoimmune diseases because they didn’t manage to target the pathways responsible for those conditions, however, since inhibiting CXCL10 would reverse vitiligo, those drugs would actually be absolutely perfect for the treatment of vitiligo because they would only inhibit the cytokine responsible for vitiligo, therefore they would be very effective and with minimal side effects.
In conclusion, there are many promising treatments for vitiligo. The first FDA approved one will likely be Xeljanz as well as topical ruxolitinib, then the antibody blockade of il-15 will be available in about 5 years (according to Dr Harris), and mutant HSPi70 will follow.  Current existing treatments for vitiligo require a lot of time and effort and they are slow, sometimes they don’t even fully work, but in a few years all this drastically change. In ten years from now (hopefully earlier) white patches on the skin caused by vitiligo will be a thing of the past, vitiligo will be nothing more than an interesting conversation at the pub when you are having a beer with your coworkers after work and you will explain  that if you don’t take a specific drug you could get white patches on your skin, it will probably even sound cool!
So far we have been talking about ten years in the future, now let’s fast forward even more, in a few decades, after we have effective treatments we will actually have a real cure! no need for any treatment anymore, you will simply be cured, no vitiligo, forever. According to Dr Harris, with current resources this will happen in 20 to 30 years from now, however he also mentioned that if we get more funding this could significantly speed up and we could potentially have a real cure in 5 to 10 years.
Sometimes I wish I had been born (or diagniosed)  a few years later,once those treatments would already be on the market, and probably you would all wish the same. In a way though, I am also looking at the glass half full: at the time of writing this post I am 39 years old, and yes I could have been born 20 years later but on the other hand if I had been born just a few centuries ago I would already be dead as life expectancy was about 30 years of age. So I may not go on a starship with an holographic doctor who can cure nearly anything in no time, but the 21st century isn’t bad either. Happy 2019 world vitiligo day everyone! 

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