Advanced Therapy Medicinal Products in Vitiligo; Current Status, Future Prospect, and Approved Treatments

Vitiligo is an auto-immune disease, causing depigmentation of skin in 0.2-1.8% of global population. Topical corticosteroids and calcineurin inhibitors are the only treatments with firm evidence of optimal effectiveness with considerable side effects. Phototherapies might not induce serious side effects, although the effectiveness of the method is limited. Advanced therapy medicinal products (ATMPs) are emerging treatment modalities based on correction and replacement of affected genes, damaged tissues or cells in treatment of difficult-to-treat diseases. Due to optimal effectiveness and minimal side effects, ATMPs have recently gained much attention in order to develop new treatments. In this review, the ATMPs for treating vitiligo were along with its clinical success, affordability and cost-effectiveness. Currently, the main ATMP based products using in treatment of vitiligo are non-cultured epidermal cell, melanocytes, and hair follicle melanocytes. These products have shown promising results in the non-responding vitiligo patients. Furthermore, mesenchymal stem cells and multi-lineage differentiating stress enduring cells are other new potential modalities. Recently, Iranian Food and Drug Administration (IR-FDA) authorized the first cell-based product for vitiligo. This product is autologous suspension of keratinocytes and melanocytes. Although ATMPs are efficient and could be cost-effective in long term, the most important obstacle is affordability of them. This could be facilitated by insurance companies and instalments payment programs from manufacturers.