Efficacy and Safety of Oral Jak Inhibitor as Current Therapy of Vitiligo: A Systematic Review

Vollständiger Abstract

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Vitiligo is an autoimmune depigmenting disorder driven by IFN-γ–mediated, CD8+ T cell cytotoxicity against melanocytes via JAK-STAT signaling. While topical ruxolitinib (JAK1/2) is FDA-approved, the efficacy and safety of oral JAK inhibitors for vitiligo remain under investigation. This systematic review evaluates current evidence for oral JAK inhibitors (upadacitinib, abrocitinib, tofacitinib) in vitiligo, including their use with adjunctive therapies. Following a PRISMA-ScR approach, PubMed was searched (2019–2026) using MeSH terms (“JAK Inhibitor” AND “Vitiligo”). Eligible designs included case reports, case series, and randomized controlled trials. Studies are organized into table with each selected data. The data extracted are explained. Evidence consists predominantly of case reports/series and one randomized trial. Oral JAK1-selective agents (upadacitinib, abrocitinib) and JAK1/3 inhibitor tofacitinib frequently produced meaningful repigmentation, especially on facial sites, with response often enhanced by light-based adjuncts (NB-UVB or 308-nm excimer). Reported examples include ~60–90% facial repigmentation with upadacitinib or abrocitinib when combined with excimer or in patients with concomitant atopic dermatitis, and near-complete facial repigmentation with tofacitinib, particularly in sun-exposed areas or when paired with NB-UVB. Abrocitinib’s higher JAK1 selectivity may preserve JAK2-mediated melanocyte survival signals, potentially explaining benefit in a case where vitiligo worsened on upadacitinib but improved after switching to abrocitinib. Safety across studies was generally acceptable, with mostly mild adverse events (e.g., acne, upper respiratory infections, fatigue, nasopharyngitis, weight gain, lipid elevations). Laboratory abnormalities were typically minimal. Oral JAK inhibitors show promising efficacy for vitiligo, particularly for facial lesions and when combined with phototherapy, with an overall favorable short- to mid-term safety profile. Adjunctive light therapy likely augments outcomes and may permit lower systemic doses.