Treatment with upadacitinib, an oral Janus kinase (JAK)-selective inhibitor, continues to improve skin repigmentation through week 76 in patients with nonsegmental vitiligo (NSV), according to the phase III Viti-Up-1 and -2 studies presented at EADV 2026.
Viti-Up-1 (n=209) and Viti-Up-2 (n=221) are ongoing multicentre, double-blind, placebo-controlled, phase III studies that evaluating adults and adolescents aged ≥12 years with NSV involving the face and body. Participants were randomized in a 2:1 ratio to receive once-daily upadacitinib 15 mg (n=140 [Viti-Up-1] and n=152 [Viti-Up-2]) or placebo (n=69 and n=69, respectively) for 48 weeks (study period A). Following the 48-week double-blind period, participants either continued upadacitinib or were switched from placebo to upadacitinib during the 112-week open-label extension (study period B). [EADV 2026, abstract 209]
Upadacitinib treatment resulted in continuous improvement in facial and total body repigmentation through week 76, in both patients receiving upadacitinib from baseline and those who switched from placebo to upadacitinib at week 48.
Facial repigmentation was assessed based on the proportion of patients achieving ≥75-percent improvement in the Facial Vitiligo Area Scoring Index (F-VASI 75). At week 76, the F-VASI 75 response rates among patients who continued upadacitinib were 55.1 percent in Viti-Up-1 and 47.4 percent in Viti-Up-2. For those who switched from placebo to upadacitinib, the corresponding rates were 24.5 percent and 16.9 percent, respectively.
At week 76, total body repigmentation was achieved by 42.5 percent (Viti-Up-1) and 40.1 percent (Viti-Up-2) in the upadacitinib group, with ≥50-percent improvement in Total VASI (T-VASI 50), and by 18.4 percent and 13.6 percent in the placebo-upadacitinib group, respectively.
In both patient groups, those who continued on upadacitinib and those who switched from placebo to upadacitinib at week 48, the proportion of patients achieving F‑VASI 75 and T‑VASI 50 increased progressively through week 76, with no apparent plateau, according to lead author Prof Julien Seneschal from the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, CHU de Bordeaux, Hôspital Saint-André, Bordeaux, France.
Viti-Up substudy
After completing study period A in Viti-Up, 84 adults (mean age 46.6 years, 56 percent female) who had not achieved a T-VASI 90 response by week 48 and who met additional eligibility criteria were rerandomized to receive either upadacitinib alone or upadacitinib plus whole-body narrow-band ultraviolet B (NB-UVB) phototherapy twice weekly for 28 weeks.
Both treatment cohorts showed improvements in facial and total body repigmentation. The combination of upadacitinib and NB-UVB resulted in numerically higher response rates than upadacitinib alone, regardless of whether patients had previously received placebo or upadacitinib.
At week 28, F-VASI 75 response rates reached 59.3 percent in the combination treatment groups, and T-VASI 50 rates reached 63 percent.
Mean percentage reductions from baseline in F-VASI and T-VASI scores were also greater with combination therapy (–78.8 percent and –58.9 percent, respectively) than with upadacitinib alone (–65 percent and –37.7 percent).
“Combining upadacitinib with NB-UVB further enhanced the efficacy of upadacitinib compared with upadacitinib monotherapy, regardless of preceding treatment (upadacitinib vs placebo). Facial and total body repigmentation efficacy rates continued to increase with upadacitinib treatment, with and without NB-UVB, over time, with no new safety signals, Seneschal noted.
“These findings are important for physicians treating people with vitiligo because they extend our understanding of repigmentation with continued upadacitinib treatment and provide the first data on combining NB-UVB with an approved systemic JAK inhibitor,” Seneschal said in a press release. “This research opens an important path for further investigation into how combination approaches could evolve to support patient care in NSV.”