College of Medicine, Babylon University, Babylon, Iraq.
Human Anatomy and Embryology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
Arch Dermatol Res. 2024 Aug 12;316(8):518. doi: 10.1007/s00403-024-03267-8.
Vitiligo, an autoimmune condition characterized by depigmented skin patches due to the loss of functional melanocytes, has been linked to dysregulation in the JAK-STAT signaling pathway, particularly in IFN-g signaling. The use of JAK inhibitors, such as ruxolitinib cream, a JAK1 and JAK2 inhibitor, presents a promising approach for vitiligo treatment. This study aims to systematically assess the effectiveness and safety of ruxolitinib cream in patients with vitiligo. We conducted a systematic review and meta-analysis following PRISMA guidelines to evaluate the efficacy and safety of ruxolitinib cream for the treatment of vitiligo. A comprehensive search of PubMed, Google Scholar, and Cochrane Library databases for randomized controlled trials (RCTs). Data selection, screening, extraction, and risk of bias assessment were meticulously performed. Statistical analysis was conducted using Review Manager Software, version 5.4, with significant heterogeneity addressed through appropriate methods. Our meta-analysis included 3 studies with 830 vitiligo patients. Significant improvements were observed in F-VASI, T-VASI, F-BSA, and T-BSA scores, with greater efficacy at 24 weeks compared to 12 weeks [MD -24.17, 95% CI (-31.78 to -16.56), P < 0.00001], [MD -14.12, 95% CI (-20.54 to -7.70); P < 0.0000], [MD -16.25, 95% CI (-22.20 to -10.31), P < 0.00001], [MD -9.19, 95% CI (-13.47 to -4.92); P < 0.00001]. Ruxolitinib showed increased risk ratios for F-VASI75, F-VASI90, and F-VASI50, indicating better outcomes with longer treatment durations [MD 2.9, 95% CI 1.88-4.49; P < 0.00001], [MD 4.66, 95% CI 2.09-10.39; P = 0.0002], [MD 2.53, 95% CI 1.84-3.46; P < 0.00001]. No significant differences were found in mild and moderate adverse events, while severe cases favored ruxolitinib. Placebo had a significant advantage in any adverse events, with no significant difference in drug-related adverse events. Serious adverse events did not significantly differ between groups. The findings strongly support the efficacy of ruxolitinib therapy in improving various parameters over time for treating vitiligo. However, thorough consideration of its safety profile, particularly concerning adverse events and potential side effects, is warranted. Further studies with larger sample sizes are needed to confirm these conclusions.
白癜风是一种自身免疫性疾病，其特征是由于功能性黑素细胞丧失而导致皮肤出现色素脱失斑块。已经发现 JAK-STAT 信号通路的失调，特别是 IFN-g 信号，与白癜风有关。使用 JAK 抑制剂，如鲁索替尼乳膏（一种 JAK1 和 JAK2 抑制剂），为白癜风的治疗提供了一种有前途的方法。本研究旨在系统评估鲁索替尼乳膏治疗白癜风的有效性和安全性。我们按照 PRISMA 指南进行了系统评价和荟萃分析，以评估鲁索替尼乳膏治疗白癜风的疗效和安全性。我们全面检索了 PubMed、Google Scholar 和 Cochrane Library 数据库中的随机对照试验（RCT）。精心进行了数据选择、筛选、提取和偏倚风险评估。使用 Review Manager Software，版本 5.4 进行统计分析，对于显著异质性采用了适当的方法进行处理。我们的荟萃分析包括 3 项研究，共 830 名白癜风患者。在 F-VASI、T-VASI、F-BSA 和 T-BSA 评分方面观察到显著改善，24 周时的疗效优于 12 周[MD-24.17，95%CI（-31.78 至-16.56），P<0.00001]，[MD-14.12，95%CI（-20.54 至-7.70）；P<0.0000]，[MD-16.25，95%CI（-22.20 至-10.31），P<0.00001]，[MD-9.19，95%CI（-13.47 至-4.92）；P<0.00001]。鲁索替尼显示出 F-VASI75、F-VASI90 和 F-VASI50 的风险比增加，表明随着治疗时间的延长，结果更好[MD 2.9，95%CI 1.88-4.49；P<0.00001]，[MD 4.66，95%CI 2.09-10.39；P=0.0002]，[MD 2.53，95%CI 1.84-3.46；P<0.00001]。轻度和中度不良反应方面无显著差异，而严重病例则有利于鲁索替尼。安慰剂在任何不良反应方面均具有显著优势，药物相关不良反应方面无显著差异。严重不良事件在各组间无显著差异。这些发现有力地支持了鲁索替尼治疗在随时间推移改善白癜风各参数方面的疗效。然而，需要充分考虑其安全性概况，特别是不良事件和潜在副作用方面的安全性。需要更大样本量的研究来证实这些结论。
