[0:15 - 3:16] How has vitiligo been treated historically?

• We can go back over 3,000 years ago to India to the Vedas (the ancient medical texts from about 1400 BC) where they talk about treatments for vitiligo.
• There is a description of finding a plant with black seeds. They told them to chew those seeds and sit out in the mid-day sun until they sweat. The chemical from that seed was effective for vitiligo but increased the risk of skin cancer.

[3:18 - 4:57] What are the currently approved treatments that we have for vitiligo?

• Light treatment - or narrowband UVB. Narrowband UVB works really well for vitiligo. It is safe and very effective.
• Creams that suppress the immune response (steroids or protopic).
• Lasers.
• Transplant pigment cells for segmental vitiligo.

[4:58 - 8:07] What new therapies are coming for vitiligo and what are JAK Inhibitors?

• In the past 5 years there has been a lot of excitement around new vitiligo treatments involving JAK inhibitors.
• Janus Kinase (JAK) is a protein responsible for sending signals or messages from cell to cell. JAK proteins are responsible for sending signals that are involved in telling your immune system to attack the melanocytes in the skin — which causes vitiligo. If you inhibit the JAK proteins, a signal doesn’t get sent and your immune system doesn’t attack your pigment-producing melanocytes.

[8:08 - 14:57] What clinical trials are underway for vitiligo and what are they showing?

• Phase II JAK inhibitor trial in a cream had very promising results — 157-patient trial.
• In short, it works. It works best for the face, but it also works on the rest of the body.
• Why it works better on the face than on the hands and the feet? Any part of the body that has a lot of hair growing on it is easy to treat. Stem cells that cause the pigment to come back to your skin are in the hair follicles.
• Now doing a phase III trial in 600 patients all over the world. That trial will take two years and then go to the FDA. It will be at least three to five years before this drug is approved.

[14:58 - 20:01] Will you have to keep taking JAK inhibitors for them to work? Why?

• Yes. That’s the case with almost any medication we use.
• Why does vitiligo come back in the exact same spots when you stop the medicine? There are immune cells that form a memory. They remember the exact spots where vitiligo will form in your body if off treatment.
• IL15 is a protein that if blocked might be a way to turn off these memory cells from forming.

[20:02 - 22:53] What are the side effects of these new therapies?

• Generally, the side effect profile from the JAK inhibitors in clinical trials looks good and the side effects look tolerable.
• 10-15% of patients in the trial of the cream or topical-based JAK inhibitors experienced localized acne where the topical was put on the skin.
• Orals in development: We don't know for sure. It is an immunosuppressant.

[22:54 - 24:45] How do I get involved in these clinical trials?

• Sign up for Dr. Harris' newsletter on the UMASS vitiligo blog.

In partnership with the Global Vitiligo Foundation