Repigmentation in vitiligo using janus kinase (JAK) inhibitors with phototherapy: systematic review and Meta-analysis

Vitiligo is an autoimmune disorder characterized by progressive loss of melanocytes, leading to cutaneous depigmentation. Vitiligo has significant psychosocial impacts on patients and is challenging to manage with limited treatment options. Recent studies have suggested promising results for JAK1/3 inhibitors including tofacitinib and ruxolitinib. To determine the expected response of vitiligo to JAK inhibitor therapy and factors which influence response rates. A systematic review and meta-analysis was performed according to PRISMA guidelines. Good response was defined as repigmentation &gt;50% or a ‘good’ or ‘excellent’ outcome as described by authors. Partial response was defined as some repigmentation &lt;50%. From the 9 eligible studies, individual patient data from 45 cases were pooled. Good response was achieved in 57.8%, partial response in 22.2%, and none or minimal response in 20% of cases. When subgrouped according to site, facial vitiligo had the highest good response rate (70%), compared to extremities (27.3%) and torso/non-sun exposed areas (13.6%). Concurrent phototherapy was significant associated with higher rates of good overall response (<i>p</i> p There is promising low-quality evidence regarding the effectiveness of JAK inhibitors in vitiligo. Concurrent UVB phototherapy appears to improve efficacy of JAK inhibitors for vitiligo.

白癜风（Vitiligo）是一种以黑素细胞进行性丢失为特征的自身免疫性疾病，可导致皮肤色素脱失。该病对患者的社会心理影响显著，且治疗选择有限，临床管理颇具挑战。近年研究显示，包括托法替布（tofacitinib）、芦可替尼（ruxolitinib）在内的JAK1/3抑制剂（JAK1/3 inhibitors）展现出了颇具前景的治疗效果。为明确白癜风对JAK抑制剂治疗的预期应答情况及影响应答率的相关因素，本研究遵循PRISMA指南开展了一项系统评价与荟萃分析。本研究将良好应答定义为复色率＞50%，或文献作者所描述的“良好”或“优秀”转归；部分应答定义为存在一定程度的复色但复色率＜50%。本次研究共纳入9项符合纳入标准的研究，合并了其中45例患者的个体数据。结果显示，57.8%的患者达到良好应答，22.2%达到部分应答，20%的患者无应答或仅出现极轻微的复色应答。按发病部位进行亚组分析时，面部白癜风的良好应答率最高（70%），相较于肢端部位（27.3%）及躯干/非日光暴露区域（13.6%）优势显著。联合光疗与更高的整体良好应答率显著相关（*p* < 0.05，原文存在排版疏漏）。现有证据表明，JAK抑制剂用于白癜风治疗具有一定前景，但证据质量较低。联合UVB光疗似乎可提升JAK抑制剂治疗白癜风的临床疗效。