TOPLINE:

About one third of patients with vitiligo did not receive treatment after being diagnosed, and treatment durations were short, according to a retrospective cohort study that evaluated vitiligo treatment patterns.

METHODOLOGY:

• Researchers conducted a retrospective cohort study of 24,949 patients (mean age, 49 years; 56.3% female) with vitiligo treated in dermatology practices and other settings across the United States from January 2018 to November 2023. Nearly 90% were 18 years or older.
• Patients had at least 12 months of baseline data and at least 3 months of follow-up after diagnosis.
• Patients were stratified by age groups (children, 0-11 years; adolescents, 12-17 years; adults, ≥ 18 years), and body surface area (BSA) involvement (≤ 10%, > 10%, and not assessed) at index date (first observed vitiligo diagnosis). Only 1329 patients (5.3%) had a BSA assessment at index.
• The face was the most frequently affected area at index among patients with reported vitiligo location (32.9% of 16,674 patients) and among those with ≤ 10% BSA involvement (43.6% of 894 patients). However, among patients with > 10% BSA involvement, the arms (52.2% of 337 patients) and trunk (52.5% of 337 patients) were the most commonly affected areas.
• Baseline demographics, clinical characteristics, and vitiligo treatment patterns following the index date were described, including treatment types, sequencing (five or fewer lines of therapy), duration, and patterns characterized by drug class and administration route.

TAKEAWAY:

• Across BSA groups, 27% of 23,620 patients without a BSA assessment to 32% of 963 patients with ≤ 10% BSA involvement did not receive treatment for vitiligo during follow-up. No substantial differences were observed across BSA groups.
• Among 653 patients with ≤ 10% BSA involvement receiving treatment, 44% received topical calcineurin inhibitors/phosphodiesterase-4 (TCI/ PDE4) inhibitors and 26% received topical JAK inhibitors. Among 262 patients with > 10% BSA involvement receiving treatment, 33% and 21% received TCI/PDE4 inhibitors and topical JAK inhibitors, respectively.
• Among 18,227 patients who initiated a first line of therapy, 64% initiated a second line of therapy, 43% a third, 29% a fourth, and 20% a fifth; the most common first-line therapies were topical corticosteroids (39%), followed by oral corticosteroids (16%) and TCI/PDE4 inhibitors (16%).
• The median treatment duration ranged from 1.8 to 4.1 months, with high variability in treatment sequences.

IN PRACTICE:

“In this cohort study, a high proportion of patients with vitiligo did not receive treatment after diagnosis,” the authors wrote, adding that “high variability in treatment sequences and short therapy duration were also observed, highlighting the lack of standardized treatment approaches.” They noted that “insights from this study could inform future research and clinical practice, potentially improving patient outcomes.”

SOURCE:

The study was led by Roni Adiri, PhD, Pfizer Pharmaceutical Israel LTD, Herzliya, Israel. It was published online on May 6 in JAMA Dermatology.

LIMITATIONS: 

The location and extent of vitiligo were not systematically recorded for all patients, and BSA was poorly documented. Reasons for treatment decisions and changes were unavailable, and claims data capture dispensed medications and prescribed duration but not actual use. Additionally, the dataset may not capture compounded medications or those not purchased through insurance, and procedural treatments could be underestimated if received outside the scope captured by claims data, such as home-based phototherapy. Treatment patterns were likely influenced by treatment availability during the study period, insurance coverage, or prior treatment exposure. Finally, results may not be generalizable to all patients with vitiligo in the United States.

DISCLOSURES:

This study was funded by Pfizer. Adiri and four other authors reported being Pfizer employees and shareholders. Several authors disclosed receiving consulting fees, personal fees, grants, and financial as well as nonfinancial support from the Global Vitiligo Foundation and many drug companies, including Pfizer. Two authors also reported being shareholders in Tara Medical. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.