To Study Role of Azathioprine vs Tofacitinib in Treatment of Vitiligo at Tertiary Care Centre: A Comparative Study

Background: Recent studies have confirmed that both hereditary and environmental influences contribute to the onset of vitiligo. Among the key immune elements involved are CD8+ T cells and Interferon-Gamma (IFN-γ), which play a critical role in melanocyte destruction. Immunomodulatory drugs like azathioprine, an oral agent with established suppressive effects on T-cell activity, have been introduced to help slow the progression of the disease. Another promising addition to the therapeutic options is tofacitinib, a Janus Kinase (JAK) inhibitor that works by blocking IFN-γ-driven inflammation-one of the central mechanisms in the formation of vitiligo patches. These developments offer new avenues for controlling immune-mediated skin damage in affected individuals. The purpose of this study was to compare the therapeutic efficacy of tofacitinib with azathioprine pulse therapy in reducing disease activity among patients with vitiligo. Aims and objectives: The aim of this study was to compare the therapeutic efficacy of tofacitinib with azathioprine pulse therapy in reducing disease activity among patients with vitiligo, as measured by changes in the Vitiligo Area Severity Index (VASI) and Body Surface Area (BSA) involvement. The primary objective was to evaluate whether tofacitinib demonstrates superior clinical outcomes compared to azathioprine. The secondary objective was to assess the safety and tolerability of tofacitinib in the treatment of vitiligo. Methodology: All patients aged above 12 years with a clinical diagnosis of vitiligo, attending the dermatology outpatient department of our institution and providing written informed consent, were enrolled in the study. Participants were randomly allocated into two groups: Group A received azathioprine at a dose of 50 mg on two non-consecutive days per week, while Group B was administered tofacitinib 5 mg twice daily. Both groups were advised to follow each dose with controlled sun exposure. Standardized clinical photographs were obtained at each monthly follow-up to monitor treatment response. Results: The mean reduction in both VASI and BSA scores was consistently greater in the tofacitinib group compared to the azathioprine group at all follow-up visits. In the azathioprine group, the average VASI scores at baseline and at the 1st, 2nd and 3rd monthly visits were 13.82, 12.25, 10.43 and 7.56, respectively. Corresponding mean BSA values were 10.65, 9.58, 8.20 and 7.61. In contrast, the tofacitinib group demonstrated a more pronounced reduction, with mean VASI scores of 14.86, 12.30, 9.32 and 6.94 across the same time points and BSA values declining from 11.35 at baseline to 9.20, 7.10 and 5.10 by the third visit. As illustrated in Fig. 1,2, the average change in both VASI and BSA from baseline was significantly higher in the tofacitinib group at each visit. Importantly, no adverse effects were reported in either treatment arm throughout the study period. Conclusion: Tofacitinib, when used in conjunction with controlled sun exposure, appears to induce more rapid repigmentation and better disease control compared to oral azathioprine pulse therapy in patients with vitiligo, as evidenced by the greater improvements in VASI and BSA scores over time.