Oral Ivarmacitinib for Stable Vitiligo: Preliminary Observations from a Three-Patient Case Series

Vitiligo is an acquired autoimmune depigmenting disorder characterized by the loss of functional melanocytes. Patients with stable vitiligo may still experience slow repigmentation, marked inter-lesional variability, and limited responses to conventional therapies. The Janus kinase-signal transducer and activator of transcription (JAK-STAT) pathway is involved in the local immune-inflammatory response in vitiligo, and the highly selective JAK1 inhibitor ivarmacitinib may therefore warrant further investigation.

This case series describes the 12-week clinical observations of three patients with stable vitiligo treated with oral ivarmacitinib. The patients included one male and two females, aged 12 to 50 years, with disease durations ranging from 9 to 36 months. The clinical subtypes included two cases of non-segmental generalized vitiligo and one case of non-segmental localized vitiligo. Two patients received ivarmacitinib 4 mg once daily, and one patient received 4 mg every other day. After 12 weeks of treatment, all three patients showed improvement in skin lesions compared with baseline. A total of 53 lesions were evaluated: 39 lesions (73.58%) showed complete or near-complete repigmentation, 12 lesions (22.64%) showed marked repigmentation, and 2 lesions (3.77%) showed moderate repigmentation; no lesions showed no response. Treatment response varied by anatomical site. Repigmentation was more pronounced on the face, neck, trunk, and extremities, whereas the response was slower on the hands and more limited on the elbows. VASI scores decreased from baseline in all three patients. No significant drug-related adverse reactions were observed during treatment.

This three-patient case series provides preliminary 12-week observational data on the use of oral ivarmacitinib for stable vitiligo. Owing to the small sample size, lack of a control group, inconsistent dosing regimens, and short follow-up period, these findings should be interpreted as descriptive clinical observations only and do not establish efficacy or long-term safety. Further validation in studies with larger sample sizes, standardized assessments, and prospective controlled designs is required.