Review Article

Efektivitas terapi inhibitor janus kinase pada vitiligo: tinjauan pustaka

Harry Gunawan , Flora Anisah Rakhmawati

Harry Gunawan
Dokter Umum, RSUD R. Syamsudin SH, Sukabumi, Jawa Barat, Indonesia. Email: gunawan.harry93@gmail.com

Flora Anisah Rakhmawati
Departemen Kulit dan Kelamin, RSUD R. Syamsyudin, SH, Sukabumi, Jawa Barat, Indonesia
Online First: August 31, 2021 | Cite this Article
Gunawan, H., Rakhmawati, F. 2021. Efektivitas terapi inhibitor janus kinase pada vitiligo: tinjauan pustaka. Intisari Sains Medis 12(2): 686-690. DOI:10.15562/ism.v12i2.956


Background: Vitiligo is an autoimmune disease that causes progressive skin melanocyte destruction, clinically seen as asymptomatic depigmentation macule and poliosis. CD8+ T cell is the primary effector of melanocyte destruction, and the activities of CD8+ T cell are driven by interferon-? (IFN-?). The current vitiligo treatment options are often not satisfied with many limitations and a high recurrence rate. Janus Kinase (JAK) inhibitor is one of the emerging vitiligo therapies which has a more specific target with a direct effect on CD8+ T cell cytotoxicity and IFN-?.

Methods: In writing this article, the literature review method was used, and sources consist of relevant journals obtained through online search engines.

Result: Several studies show that repigmentation in the facial area increases between 51-92%. Repigmentation occurs better in areas exposed to sunlight or a combination of phototherapy because repigmentation in vitiligo lesions requires suppression of the autoimmune process and melanocyte regeneration.

Conclusion: Many studies showed the results of vitiligo therapy using JAK inhibitors were very promising and safe. The vitiligo therapy using JAK inhibitor showed higher efficacy on the facial area and combined with ultraviolet exposure.

 

Latar belakang: Vitiligo merupakan penyakit autoimun yang menyebabkan destruksi melanosit secara progresif pada kulit, menimbulkan makula depigmentasi asimtomatik dan poliosis. Sel T CD8+ merupakan efektor primer yang menyebabkan kematian melanosit dan aktivitasnya ditingkatkan oleh interferon-? (IFN-?). Pilihan terapi vitiligo saat ini seringkali tidak memuaskan, memiliki keterbatasan, dan memiliki tingkat kekambuhan yang tinggi. Inhibitor Janus Kinase (JAK) merupakan salah satu terapi baru vitiligo yang memiliki target lebih spesifik dengan efek langsung terhadap sitotoksisitas sel T CD8+ dan IFN-?.

Metode: Dalam penulisan artikel ini digunakan metode tinjauan pustaka dengan bersumber pada artikel relevan yang didapatkan melalui pencarian secara daring.

Hasil: Beberapa studi menunjukkan adanya repigmentasi pada area wajah meningkat antara 51-92%. Repigmentasi terjadi lebih baik pada area terpapar sinar matahari atau kombinasi fototerapi disebabkan karena repigmentasi pada lesi vitiligo membutuhkan supresi dari proses autoimun dan regenerasi melanosit.

Simpulan: Berbagai studi menunjukkan hasil terapi inhibitor JAK terhadap vitiligo sangat menjanjikan dan cukup aman. Terapi inhibitor JAK menunjukkan efektivitas lebih tinggi pada area wajah dan dengan kombinasi paparan ultraviolet.

References

Ezzedine K, Harris JE. Vitiligo. In: Fitzpatrick’s Dermatology. 9th ed. USA: McGraw-Hill Education; 2019. p. 1330–50.

Passeron T, Ortonne J-P. Vitiligo and Other Disorders of Hypopigmentation. In: Dermatology. 4th ed. USA: Elsevier; 2018. p. 1087–114.

Karagaiah P, Valle Y, Sigova J, Zerbinati N, Vojvodic P, Parsad D, et al. Emerging drugs for the treatment of vitiligo. Expert Opin Emerg Drugs. 2020 Jan 2;25(1):7–24.

Anstey AV. Disorders of Skin Colour. In: Rook’s Textbook of Dermatology. 8th ed. Wiley-Blackwell; 2010. p. 58.1-58.59.

Frisoli ML, Essien K, Harris JE. Vitiligo: Mechanisms of Pathogenesis and Treatment. Annu Rev Immunol. 2020 Apr 26;38(1):621–48.

Howell MD, Kuo FI, Smith PA. Targeting the Janus Kinase Family in Autoimmune Skin Diseases. Front Immunol [Internet]. 2019 Oct 9 [cited 2020 Sep 28];10. Available from: https://www.frontiersin.org/article/10.3389/fimmu.2019.02342/full

Taieb A, Alomar A, Böhm M, Dell’Anna ML, De Pase A, Eleftheriadou V, et al. Guidelines for the management of vitiligo: the European Dermatology Forum consensus: EDF vitiligo guidelines. Br J Dermatol. 2013 Jan;168(1):5–19.

Mulekar SV, Isedeh P. Surgical interventions for vitiligo: an evidence-based review. Br J Dermatol. 2013 Oct;169:57–66.

Craiglow BG, King BA. Tofacitinib Citrate for the Treatment of Vitiligo: A Pathogenesis-Directed Therapy. JAMA Dermatol. 2015 Oct 1;151(10):1110.

Bishnoi A, Parsad D. Clinical and Molecular Aspects of Vitiligo Treatments. Int J Mol Sci. 2018 May 18;19(5):1509.

Bergqvist C, Ezzedine K. Vitiligo: A Review. Dermatology. 2020 Mar 10;1–22.

Relke N, Gooderham M. The Use of Janus Kinase Inhibitors in Vitiligo: A Review of the Literature. J Cutan Med Surg. 2019 May;23(3):298–306.

Damsky W, King BA. JAK inhibitors in dermatology: The promise of a new drug class. J Am Acad Dermatol. 2017 Apr;76(4):736–44.

Rothstein B, Joshipura D, Saraiya A, Abdat R, Ashkar H, Turkowski Y, et al. Treatment of vitiligo with the topical Janus kinase inhibitor ruxolitinib. J Am Acad Dermatol. 2017 Jun;76(6):1054-1060.e1.

Joshipura D, Alomran A, Zancanaro P, Rosmarin D. Treatment of vitiligo with the topical Janus kinase inhibitor ruxolitinib: A 32-week open-label extension study with optional narrow-band ultraviolet B. J Am Acad Dermatol. 2018 Jun;78(6):1205-1207.e1.

Rosmarin D, Pandya AG, Lebwohl M, Grimes P, Hamzavi I, Gottlieb AB, et al. Ruxolitinib cream for treatment of vitiligo: a randomised, controlled, phase 2 trial. The Lancet. 2020 Jul;396(10244):110–20.

Harris JE, Rashighi M, Nguyen N, Jabbari A, Ulerio G, Clynes R, et al. Rapid skin repigmentation on oral ruxolitinib in a patient with coexistent vitiligo and alopecia areata (AA). J Am Acad Dermatol. 2016 Feb;74(2):370–1.

Vu M, Heyes C, Robertson SJ, Varigos GA, Ross G. Oral tofacitinib: a promising treatment in atopic dermatitis, alopecia areata and vitiligo. Clin Exp Dermatol. 2017 Dec;42(8):942–4.

Tajalli M, Kabir S, Vance TM, Qureshi AA. Effective use of oral tofacitinib and phototherapy in a patient with concomitant alopecia areata, vitiligo, and plaque and inverse psoriasis. Clin Case Rep. 2020 May;8(5):819–22.

Komnitski M, Komnitski A, Komnitski Junior A, Silva de Castro CC. Partial repigmentation of vitiligo with tofacitinib, without exposure to ultraviolet radiation. An Bras Dermatol. 2020 Jul;95(4):473–6.

Joshipura D, Plotnikova N, Goldminz A, Deverapalli S, Turkowski Y, Gottlieb A, et al. Importance of light in the treatment of vitiligo with JAK-inhibitors. J Dermatol Treat. 2018 Jan 2;29(1):98–9.

Liu LY, Strassner JP, Refat MA, Harris JE, King BA. Repigmentation in vitiligo using the Janus kinase inhibitor tofacitinib may require concomitant light exposure. J Am Acad Dermatol. 2017 Oct;77(4):675-682.e1.

Gianfaldoni S, Tchernev G, Wollina U, Roccia MG, Fioranelli M, Lotti J, et al. Micro - Focused Phototherapy Associated To Janus Kinase Inhibitor: A Promising Valid Therapeutic Option for Patients with Localized Vitiligo. Open Access Maced J Med Sci. 2018 Jan 21;6(1):46–8.

Kim SR, Heaton H, Liu LY, King BA. Rapid Repigmentation of Vitiligo Using Tofacitinib Plus Low-Dose, Narrowband UV-B Phototherapy. JAMA Dermatol. 2018 Mar 1;154(3):370.

McKesey J, Pandya AG. A pilot study of 2% tofacitinib cream with narrowband ultraviolet B for the treatment of facial vitiligo. J Am Acad Dermatol. 2019 Aug;81(2):646–8.


No Supplementary Material available for this article.
Article Views      : 24
PDF Downloads : 7