Efficacy and safety of oral JAK inhibitors in patients with nonsegmental vitiligo: a systematic review of randomized clinical trials
DOI:
https://doi.org/10.70577/xxapny52Keywords:
Vitiligo; Janus kinase inhibitors; Administration, oral; Randomized controlled trial; Repigmentation; Patient safety.Abstract
The management of nonsegmental vitiligo involves controlling disease activity and promoting repigmentation, while considering whether treatment risks outweigh the benefits obtained. The objective was to analyze the efficacy and safety of oral JAK inhibitors compared with placebo or conventional treatments. A systematic review was conducted through searches in PubMed, Scopus, and Web of Science on September 12, 2026, considering a five-year publication window and reports in English or Spanish. Of 315 records, 155 duplicates were removed and 160 were screened, with 128 excluded after title and abstract assessment; evaluation of 32 complete articles led to the inclusion of 28 publications from nine trials involving 1575 randomized participants. A narrative synthesis was performed, with RoB 2 assessment and certainty appraisal for each comparison. Results were more consistent for upadacitinib versus placebo, with facial improvement of at least 75% achieved by 25% and 23% of participants in the two phase 3 trials, compared with 6% and 7% at 48 weeks. Ritlecitinib and povorcitinib showed benefits that varied by outcome, while comparisons with corticosteroids and phototherapy had greater limitations. Serious adverse events were uncommon, although follow-up was insufficient to exclude uncommon or delayed risks. Therefore, interpretation should consider the drug, treatment duration, and comparator, without establishing therapeutic equivalence or long-term safety, since findings from individual trials cannot be applied uniformly to other treatments or patient groups.
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