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GLOBAL CONFERENCE DISCUSSES PROMISING FUTURE FOR VITILIGO TREATMENTS

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Global conference discusses promising future for vitiligo treatments

 Posted on 23rd December 2024  5 minute read

The 4th Vitiligo International Patient Organisations Committee (VIPOC)  Vitiligo Conference in Cairo aimed to bring together patient leaders, healthcare providers, and researchers to shape the future of vitiligo care. This is vitiligo advocacy on an international stage, where patient voices and medical experts from around the globe come together to shape the future of vitiligo awareness and treatment .

The 4 day event saw patient organisations come together to explore the following global and local themes:

  • Patient participation in the development of national guidelines 
  • Harnessing research data to enable better patient advocacy 
  • Current clinical trials and treatments in development
  • Methods to engage younger members 
  • The role of autoimmunity and associated diseases
  • Real world experiences of Ruxolitinib
  • The impact of Jak inhibitors and the future of treatment 

The Vitiligo Society was there to share the work happening in the UK and understand what work and process was being undertaken by international vitiligo patients support groups to better understand the diverse ways in which we can support patients in the UK.

Especially important to us was to learn more about what the future of vitiligo treatment could look like; and to understand what impact Ruxolitinib was having in other countries, as we continue to fight to make it available through the NHS. 

Below were some of the highlights we took away:

Real world experiences Ruxolitinib

Professor Markus Bohm shared real world experiences of using topical Ruxolitinib for treating patients in Germany. Professor Bohm explained that real world experience showed ‘a promising therapeutic effect of topical ruxolitinib in non-segmental vitiligo, with narrow-band UVB and other energy devices potentially having additional add-on effects.

He did, however, share some potentially limiting factors to this treatment:

  • Topical Ruxolitinib was less effective when damage is being cause to the skin – i.e. when shaving the area regularly
  • Similarly the treatment was less responsive in areas of friction, and not responding to areas where the hair had also lost pigmentation.
  • Patients found that generally they needed to persevere with the treatment for 6-12 months before they saw significant results, and it was thought that if treatment was stopped then the skin would likely not maintain repigmentation. 
  • The treatment was not effective on patients with segmental vitiligo, but there may be better results for this if the treatment is delivered following an early diagnosis.

In addition, clinics in Germany is treating patients as young as 6 years old. This is considered ‘off label’ treatment and there are clinical trials being undertaken with children under 12 that will be published soon – so its generally believed to be safe for younger patients under the approved age of 12. Professor Bohm shared that he would reasonably expect Ruxolitinib to be approved for children under 12 in the near future.

More Jak Inhibitors are on the way

Professor Thierry Passeron provided an update the different stages of clinical trials and the 3 objectives that are evaluated in relation to vitiligo treatments:

  • To halt depigmentation
  • To induce repigmentation (usually over a 6-25 month period)
  • To prevent relapses

He gave an update on the current family of Jak Inhibitor treatments that are licenced, Ruxolitinib, and currently in trial: Ritlecitinib, Povorcitinib, Upadacitinib, Baracitinib and Afamelanotide, in relation to their performance again these outcomes.

Current research suggesting a promising future with new drugs for vitiligo

First, Dr. Harris described research that led to the development and  approval of topical jak Inhibitor, Ruxolitinib for vitiligo. Vitiligo is an autoimmune condition, and the immune system is made up of t-cells antibodies, complexes, cytokines. Auto immunity is a system so strong that it then attacks its own cells. He reflected that in the last 15 years we have come to understand vitiligo better which has really launched the last round of treatments and enable the development of targeted immunotherapies that can treat vitiligo while avoiding the side effects of systemic immunotherapy. This means that Jak Inhibitors that are being developed seek to ‘switch off’ elements of the immune system that play a role in the occurrence of vitiligo repigmentation, without turning off the whole immune system. 

His research described the interferon gamma (IFN-γ) signaling pathway and showed that inhibition of pathway components prevented and reversed vitiligo in mice. Initial human studies showed that Janus Kinase inhibitors can treat vitiligo, providing the basis for testing in clinical trials.

Dr Harris’ presentation then shared research that identified skin-resident memory T cells as a new target for vitiligo treatment. Research shows that between 40%-50% of patients who stop vitiligo treatment experience a relapse of pigmentation within one year. In addition research shows that vitiligo almost always comes back to the same place, suggesting that the skin ‘remembers’ the vitiligo. This led to research 

Research showed that these skin-resident memory T cells are highly sensitive to interleukin- (IL-) 15 blockers, a new therapeutic target. This finding led to the development of the antibody Auremolimab that targets the IL-15 receptor. Dr Harris shared that preclinical trials were promising. This means that this new form of vitiligo treatment could address the high prevalence of ‘relapse’ that patients experience with current treatment options. 

In addition to this potential new wave of future treatments, Dr. Harris presented ongoing research to better understand vitiligo beyond the IFN-γ and IL-15 pathways. This research analyzed samples from patients’ skin using single-cell RNA sequencing to map a network of cellular communication. RNAi – is a small molecule that can be used to target genes.

If we can turn off a gene that causes vitiligo then we may be able to turn off that immune response. For vitiligo we could potentially use siRNA to target JAK1 and this would turn off gamma signals which rally the immune response. Where JAK inhibitors turn of all JAK proteins this would just turn off the one we need to target. It also is potentially more effective and also would potentially only need to be administered twice a month (as it lasts longer). However researchers would need to change the chemistry of these, to stop the body automatically destroying them and to get them into the right place. Further study of these networks could offer additional opportunities for new ‘novel’ therapies. Dr. Harris hopes that dermatologists ten years from now will have even more improved treatment options for patients with vitiligo.

The importance of the international community

Whilst The Vitiligo Society focuses on supporting patients within the UK, events like this demonstrate the global efforts from clinicians and researchers to learn more about vitiligo and ensure that this learning shapes considerations for potential new treatments. We have an important role in ensuring that the needs of the UK patients are heard by this community and to advocate for UK patients to have the same access to treatments that international patients are benefitting from.

You can learn more about The Vitiligo International Patient Organisations Committee (VIPOC) by vitising https://www.vipoc.org/

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