Post Hoc Subgroup and Body Region Analyses of VASI Outcomes Among Patients with Vitiligo in a Phase 2 Povorcitinib Trial

A phase 2 trial (NCT04818346) of the oral Janus kinase 1 inhibitor povorcitinib demonstrated substantial total body and facial repigmentation over 52 weeks in adults with extensive nonsegmental vitiligo (NSV). Here, post hoc analyses evaluated povorcitinib efficacy in patients based on demographic and clinical characteristic subgroups, as well as affected body regions. Data were pooled for 103 patients in the extension-evaluable population who received povorcitinib (15, 45, or 75 mg once daily) throughout the 52-week study. Efficacy among subgroups was evaluated using achievement of ≥ 50% reduction from baseline in total Vitiligo Area Scoring Index (T-VASI50) and ≥ 50%/≥ 75% reduction from baseline in facial VASI (F-VASI50/F-VASI75). Efficacy in the affected body regions was evaluated using VASI50 responses. Data were analyzed using descriptive statistics, and missing values were imputed as nonresponders. At Week 52, 34.0% (35/103) of patients achieved T-VASI50, 61.2% (63/103) achieved F-VASI50, and 45.6% (47/103) achieved F-VASI75. Repigmentation occurred across subgroups regardless of patient age, sex, race, Fitzpatrick skin type, affected body surface area, other autoimmune comorbidities, disease duration, or prior NSV treatment. In addition, VASI50 response rates increased consistently and, in most cases, without plateauing for each body region, ranging from 25.8% for the feet to 57.3% for the head and neck (excluding the face). Decreased rates of disease activity were also evident across body regions. In this exploratory post hoc analysis of adults with extensive NSV, oral povorcitinib produced clinically meaningful repigmentation (as measured by achievement of T-VASI50 and F-VASI75) across patient characteristic subgroups and body regions through 1 year of treatment. Response rates varied by body region, reinforcing the lengthy repigmentation process, especially in nonfacial areas, and highlighting the need to manage patient expectations and encourage adherence to long-term therapy. ClinicalTrials.gov identifier, NCT04818346. Vitiligo is a condition that causes the skin to form white patches. These patches can develop anywhere on the body. In a recent study, people with widespread vitiligo took povorcitinib tablets daily for 1 year. Many saw color return to the white patches of skin on their face and body. The analysis described here examined data from this study and assessed how well the treatment worked in different groups of people based on factors such as age, skin tone, duration of vitiligo, prior treatments, and affected body parts. The analysis included 103 patients who took povorcitinib for 1 year. After a year of treatment, one in three patients had at least half of the lost color return across their body. The face responded even better—nearly half the patients had at least three-quarters of their color return. Importantly, povorcitinib improved skin coloring across different groups of people, regardless of their age, sex (men/women), race, skin tone (fairer/darker), or how much of the body was affected with vitiligo. It also helped people whether they had other autoimmune health problems or not, had vitiligo for a short or long time, or had tried other medicines before. Povorcitinib also worked on different parts of the body, although results were best on the face and the head and neck. Since treatment takes many months and results may appear slowly in some body areas (e.g., the hands and feet), patients should be encouraged to continue treatment long term for the best outcomes.