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Apremilast and narrowband ultraviolet B combination therapy suppresses Th17 axis and promotes melanogenesis in vitiligo skin: a randomized, split-body, pilot study in skin types IV–VI

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Abstract

Improved repigmentation of generalized vitiligo in skin types IV–VI has been reported in clinical response to combined therapy with apremilast and narrowband (NB)-UVB; however, tissue responses to combined therapy versus NB-UVB monotherapy have not been elucidated. We compared the change from baseline in cellular and molecular markers in vitiligo skin after combined therapy versus NB-UVB monotherapy. We assessed lesional and nonlesional skin samples from enrolled subjects and evaluated for immune infiltrates, inflammatory, and melanogenesis-related markers which were compared across different treatment groups. Combined therapy resulted in significant reduction of CD8+T cells and CD11c+ dendritic cells, downregulation of PDE4B and Th17-related markers, and upregulation of melanogenesis markers. This study was limited to small sample size, skin types IV–VI, and high dropout rate. Our molecular findings support the clinical analysis that apremilast may potentiate NB-UVB in repigmentation of generalized vitiligo in skin types IV–VI.

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Acknowledgements

This study received funding from Celgene Corporation.

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Author notes

  1. Mark G. Lebwohl and Emma Guttman-Yassky: these authors equally contributed to the manuscript.

Authors and Affiliations

  1. Department of Dermatology, Icahn School of Medicine and Mount Sinai, New York, NY, 10029, USA

    Hee J. Kim, Ester Del Duca, Ana B. Pavel, Giselle K. Singer, Brian J. Abittan, Margot A. Chima, Grace Kimmel, Jennifer Bares, Danielle Baum, Matthew Gagliotti, Jordan Genece, Justin Chu, Mark G. Lebwohl & Emma Guttman-Yassky

  2. Department of Biomedical Engineering, University of Mississippi, University, MS, USA

    Ana B. Pavel

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Correspondence to Hee J. Kim.

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Conflict of interest

Dr. Lebwohl has received research funds from Abbvie, Amgen, Arcutis, AstraZeneca, Boehringer Ingelheim, Celgene, Clinuvel, Corrona.Inc, Eli Lilly, Foundation for Research & Education in Dermatology, Incyte, Janssen Research & Development, Kadmon Corp, Leo Pharmaceuticals, MedImmune, Novartis, Ortho Dermatologics, Pfizer, Sciderm, UCB.Inc, and ViDac, and is a consultant for Allergan, Almirall, Arcutis, Boehringer Ingelheim, Bristol-Myers Squibb, Castle Biosciences, Leo Pharma, Menlo, Mitsubishi, Neuroderm, Pfizer, Promius/Dr. Reddy's Laboratories, Theravance, and Verrica. Dr. Guttman has received research funds from Abbvie, Celgene, Eli Lilly, Janssen, MedImmune/AstraZeneca, Novartis, Pfizer, Regeneron, Vitae, Glenmark, Galderma, Asana, Innovaderm, Dermira and UCB, and is also a consultant for Sanofi Aventis, Regeneron, Stiefel/GlaxoSmithKline, MedImmune, Celgene, Anacor, AnaptysBio, Dermira, Galderma, Glenmark, Novartis, Pfizer, Vitae, Leo Pharma, Abbvie, Eli Lilly, Kyowa, Mitsubishi Tanabe, Asana Biosciences, and Promius. Other authors have no conflicts of interest to declare.

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Kim, H.J., Del Duca, E., Pavel, A.B. et al. Apremilast and narrowband ultraviolet B combination therapy suppresses Th17 axis and promotes melanogenesis in vitiligo skin: a randomized, split-body, pilot study in skin types IV–VI. Arch Dermatol Res 315, 215–221 (2023). https://doi.org/10.1007/s00403-022-02343-1

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