Demographic factors associated with response to topical Jak inhibitors in a diverse vitiligo cohort

Vitiligo is a chronic autoimmune disorder that causes progressive melanocyte destruction and a significant psychosocial burden. Topical Jak inhibitors including ruxolitinib cream, are a Food and Drug Administration-approved treatment option. Real-world data on treatment response across diverse patient populations remain limited. This single-institution retrospective cohort study (April 2018-2024) included 120 patients with vitiligo from a Southern California academic medical center. Eligibility criteria included ≥2 dermatology visits, Vitiligo Area Scoring Index scores, insurance documentation, and current topical Jak inhibitor treatment. Bivariate analyses and multivariable Firth logistic regression were performed. The cohort was 34.2% Asian, 16.6% Hispanic, and 49.2% White. On bivariate analyses, Hispanic ethnicity (50% vs 27% non-Hispanic, P = .042) and longer treatment duration (P = .010) were significantly associated with Vitiligo Area Scoring Index improvement. On multivariable analysis, treatment duration remained an independent predictor (adjusted OR = 1.11 per month, 95% confidence interval = 1.04-1.20, P < .001), whereas non-Hispanic ethnicity had 69% lower odds of improvement (adjusted OR = 0.307, 95% confidence interval = 0.099-0.912, P = .034). Publicly insured patients experienced higher Jak inhibitor denial rates (60% vs 40%, P = .018). In this diverse real-world cohort, Hispanic ethnicity and longer treatment duration were independently associated with Vitiligo Area Scoring Index improvement. Insurance-related disparities and limited representation of certain minority groups highlight inequities in access to vitiligo care. Larger studies that incorporate standardized outcomes are needed.