Almost half of newly diagnosed patients with vitiligo in the United States do not receive any treatment within the first 12 months following initial diagnosis, according to study results published in Dermatology and Therapy.
Ruxolitinib is the only US Food and Drug Administration-approved treatment for repigmentation; other available agents are limited due to inadequate efficacy and poor side effects associated with long-term use. As a result, vitiligo may be severely undertreated; however, evidence is lacking in regards to treatment utilization.
Therefore, investigators conducted a retrospective analysis to assess treatment patterns and medication utilization among patients with vitiligo in the first year of diagnosis. They sourced data from Merative MarketScan Research Databases between October 2016 and April 2021. Patients with bullous disorders, dermatitis, eczema, or pigmentation disorders other than vitiligo were excluded from the study, as were patients with evidence of vitiligo-related treatment during the 12-month baseline period.
Patients included in the study (N=19,335) were aged 12 years and older, mean (SD) age was 41.6 (14.0) years, and 82.2% of patients were women. The most common comorbidities at baseline were gastrointestinal disease (28.2%), cardiovascular disease (26.7%), and hypertension (19.8%).
The investigators found that 49.9% of patients (n=9648) were without treatment during the 12-month follow-up period. Among patients who initiated treatment, most were prescribed oral corticosteroids (21.0%), high-potency topical corticosteroids (20.2%), and topical calcineurin inhibitors (TCIs, 14.1%) as first-line therapies.
Patients (n=13,449) without vitiligo-related treatment prior to diagnosis also did not receive treatment postdiagnosis (56.5%) within the first year of follow-up. Among patients in this study group, some later initiated treatment (n=5845) and rarely switched therapies, which included high-potency topical corticosteroids (25.4%), oral corticosteroids (23.1%), and TCIs (14.7%). The longest (SD) time to treatment was 153.3 (108.3) days. The investigators also noted that TCIs were the most common first-line treatment (30.9%) used by adolescents initiating treatment (n=486).
Among patients (n=3462) with moderate-to-severe vitiligo, 73.1% were treated with oral corticosteroids, and 1.5% did not receive treatment. Analysis by age revealed that adolescents (n=205) were unlikely to switch treatment during the study period.
Mean (SD) time to first medication claim ranged from 51.9 (84) days for TCI to 178.6 (116) days for systemic immunosuppressants among patients with no vitiligo-related treatment prior to diagnosis. Mean (SD) total days of medication supplied ranged from 14.4 (27.1) days for oral corticosteroids to 121.0 (114) days for immunosuppressants.
There were several study limitations. The definition of moderate to severe vitiligo used was empirical, not clinically driven, and used as a proxy in the absence of established disease activity measures. In addition, definitive treatment guidelines for vitiligo are not currently available. There may have also been unknown reporting errors in electronic data. Furthermore, information on use of over-the-counter medications was incomplete among included patient. Finally, the study results may be prone to bias owing to nonrandom selection into the treatment group (with patients possibly more representative of commercially insured patients than the general population).
“A high proportion of patients newly diagnosed with vitiligo did not receive any treatment,” the investigators concluded. They added, “To help better understand the needs of patients with vitiligo, future studies need to examine which demographic and clinical characteristics are associated with not receiving treatments for vitiligo.”
References:
Rosmarin D, Soliman A, Li C. Real-world treatment patterns in patients with vitiligo in the United States. Dermatol Ther (Heidelb). Published online August 7, 2023. doi:10.1007/s13555-023-00983-3
