PA13 Comparison of oral minipulse dexamethasone and tofacitinib in progressive nonsegmental childhood vitiligo

Abstract Childhood vitiligo is a distinct subset of vitiligo with different clinical characteristics and response to treatment. The main aims of treatment include arrest of progression and repigmentation. Oral minipulse (OMP) with steroids has proved cost-effective and efficacious in terms of disease stabilization and repigmentation in progressive childhood vitiligo. Janus kinase inhibitors such as oral tofacitinib have proven to be an effective and well-tolerated modality for childhood vitiligo in recent case series. The objective of this study was to compare the efficacy and safety of monotherapy with OMP dexamethasone vs. tofacitinib in stabilizing disease activity and inducing repigmentation in childhood vitiligo. This randomized, investigator-blinded, two-arm prospective study included 30 children (aged 6–18 years) with actively spreading nonsegmental vitiligo. The participants were randomized to receive either OMP dexamethasone (2.5 mg on two consecutive days per week) or tofacitinib (5 mg once or twice daily based on weight) for 24 weeks followed by 12 weeks of observation. All other topical and systemic treatments were withheld. The stabilization of disease activity was assessed using the Vitiligo Disease Activity (VIDA) score, while repigmentation was evaluated by Vitiligo Extent Score (VES) at baseline and weeks 4, 12, 24 and 36. VES 50 (≥ 50% repigmentation) and VES 75 (≥ 75% repigmentation) were also assessed at 36 weeks. Safety outcomes were monitored through laboratory parameters and adverse event reporting. Both groups were comparable in terms of age, duration of disease, sex, family history, past treatment and total body surface area involved. Early arrest of disease progression (defined by decrease in VIDA score from baseline at 4 weeks) was observed in 10 of 15 (67%) patients in the OMP group vs. seven of 15 (47%) in the tofacitinib group, although the difference was statistically insignificant (P = 0.46). The mean VES score at baseline (2.0 for OMP vs. 3.6 for tofacitinib) (P = 0.36) showed a decreasing trend to 36 weeks (0.7 for OMP vs. 1.5 for tofacitinib), with no significant difference between the two groups (P = 0.49). VES 50 was observed in 11 of 15 (73%) in the OMP group vs. nine of 15 (60%) in the tofacitinib group, with no difference between the two groups (P = 0.70). VES 75 was observed in five of 10 (33%) patients each in the OMP and tofacitinib groups (P > 0.99). Adverse events included transient gastrointestinal discomfort, hirsutism, weight gain in the OMP group and mild dyslipidaemia in the tofacitinib group. Both OMP dexamethasone and tofacitinib demonstrated efficacy in stabilizing disease activity and inducing repigmentation in childhood vitiligo. OMP showed a slightly greater trend towards earlier arrest of disease progression, while both therapies demonstrated similar repigmentation outcomes at 36 weeks. Safety profiles were acceptable, with minimal adverse events in both groups.