1. In patients with vitiligo, treatment with a combination of afamelanotide and narrowband UV-B (NB-UV-B) phototherapy resulted in faster re-pigmentation compared with NB-UV-B monotherapy.
Evidence Rating Level: 2 (Good)
Study Rundown: Vitiligo, an autoimmune condition in which there are loss of melanocytes, presents as patches of depigmented skin. Afamelanotide is a stimulator of the melanocortin cascade that has in recent years been shown to have efficacy in the treatment of vitiligo. Study investigators combined the use of mainstay NB UV-B phototherapy with afamelanotide to compare it to the efficacy of NB UV-B monotherapy. Results showed that a combination of afamelanotide and NB-UV-B phototherapy produced more timely and improved repigmentation than monotherapy alone. The study’s inherent strength was derived from the randomized control design, with the limitation that the study was focused on patients with dark skin who are inherently more responsive to vitiligo treatment.
In-Depth [randomized multicenter trial]: Fifty-five Fitzpatrick skin types III-VI patients with vitiligo were randomized to either combination NB-UV-B phototherapy with afamelanotide or NB-UV-B monotherapy (28 and 27 patients respectively). Patients were seen at 8 consecutive visits during 7 months. Both groups received NB-UV-B phototherapy 2-3 times weekly for 6 months, with the combination arm receiving 4 monthly subcutaneous afamelanotide implants. At each visit, repigmentation was assessed. Results varied by anatomic location; particularly for the face and upper extremities. More patients achieved repigmentation at earlier times in the combination treatment arm (41 vs. 61 days for the face, 46 vs. 69 days for the upper extremities for combination vs. monotherapy, p=0.001 and p=0.003 respectively). At day 168, while repigmentation was 48.64% in the combination therapy group, it was 33.26% in the NB-UV-B monotherapy group (95% CI 24.18%-42.33%). A future avenue for research would be an additional arm assessing afamelanotide as monotherapy.
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