Upadacitinib sustains repigmentation in non-segmental vitiligo through 76 weeks

For adolescents and adults with non-segmental vitiligo (NSV), repigmentation with once-daily oral upadacitinib appears to keep deepening beyond 48 weeks. In the ongoing phase 3 Viti-Up-1 and Viti-Up-2 studies, the share of patients reaching at least 75% facial repigmentation (F-VASI 75) and at least 50% total body repigmentation (T-VASI 50) rose between weeks 48 and 76 among those continuing upadacitinib 15 mg, according to late-breaking data presented at the 2026 European Academy of Dermatology and Venereology Congress.¹

The findings "extend our understanding of repigmentation with continued RINVOQ treatment and provide the first data on combining NB-UVB with an approved systemic JAK inhibitor," said Julien Seneschal, MD, PhD, professor of dermatology at the National Reference Center for Rare Skin Diseases, University of Bordeaux, France.¹

Upadacitinib week-76 repigmentation results in Viti-Up-1 and Viti-Up-2

The replicate, double-blind trials randomized 614 patients aged 12 years and older with NSV involving the face and body 2:1 to upadacitinib 15 mg or placebo once daily for 48 weeks.² At week 48, upadacitinib met both coprimary endpoints in each study: T-VASI 50 was reached by 19% vs 6% of patients in Viti-Up-1 and 21% vs 6% in Viti-Up-2, and F-VASI 75 by 25% vs 6% and 23% vs 7%, respectively (P < .001).²

Patients completing the placebo-controlled period could enter a 112-week open-label extension.¹ Among those who continued upadacitinib, observed-case F-VASI 75 rates increased from 33.1% at week 48 to 55.1% at week 76 in Viti-Up-1 and from 27.6% to 47.4% in Viti-Up-2.¹ T-VASI 50 rates rose from 29.2% to 42.5% and from 26.2% to 40.1%, respectively.¹ Safety through week 76 was consistent with the drug's known profile, with no new signals reported.¹

Upadacitinib plus NB-UVB phototherapy substudy in vitiligo

A substudy re-randomized 84 adults who had not achieved T-VASI 90 at week 48 to upadacitinib alone or combined with twice-weekly whole-body narrowband UVB (NB-UVB) for 28 weeks.¹ Among patients previously treated with upadacitinib (n = 27 per arm), T-VASI 50 was reached by 63.0% with combination therapy vs 33.3% with monotherapy, and F-VASI 75 by 59.3% vs 37.0%.¹

Among prior placebo recipients (n = 15 per arm), corresponding T-VASI 50 rates were 33.3% vs 20.0%.¹ AbbVie characterized the differences as numerical, and no statistical comparison was reported.¹

Pediatric vitiligo burden and current treatment options

Vitiligo affects an estimated 0.5% to 2% of the global population, and durable repigmentation remains difficult to achieve with corticosteroids, calcineurin inhibitors, and phototherapy.⁴ Children account for approximately 30% of cases and often face prolonged treatment courses, access barriers, and significant psychosocial effects.³

Topical ruxolitinib 1.5% cream is approved for patients 12 years and older, but no systemic therapy had been approved for NSV before upadacitinib.²,³

Upadacitinib mechanism and regulatory status in non-segmental vitiligo

Upadacitinib is a selective, reversible JAK inhibitor that preferentially inhibits JAK1 or JAK1/3 signaling.¹ The European Commission approved it in July 2026 for NSV in patients 12 years and older who are candidates for systemic therapy, based on week-48 Viti-Up data; the indication is under FDA review.¹

European labeling notes a higher incidence of hypercholesterolemia with upadacitinib than placebo in vitiligo trials, as well as reports of skin papilloma in adolescents with long-term exposure in atopic dermatitis studies.¹

Limitations of the Viti-Up extension and phototherapy data

The week-76 results are observed-case analyses limited to patients who remained on treatment, which can yield higher response rates than intention-to-treat estimates. This likely explains why week-48 rates in the extension population exceed those reported in the primary publication.¹,²

The phototherapy substudy was small, enrolled only adults, and was not designed for formal between-group comparison, so its findings should be considered hypothesis-generating. The data have not yet been peer-reviewed, and results were not reported separately for adolescents.¹

Even with continued therapy, more than half of patients had not reached T-VASI 50 at week 76, and T-VASI 75 at week 48 did not differ from placebo.¹,² The extension continues through week 160, which should further clarify durability and long-term safety.¹

References

1. AbbVie presents long-term RINVOQ (upadacitinib) data showing continued repigmentation in non-segmental vitiligo. News release. AbbVie. October 1, 2026. Accessed October 1, 2026. https://news.abbvie.com/2026-10-01-AbbVie-Presents-Long-Term-RINVOQ-R-upadacitinib-Data-Showing-Continued-Repigmentation-in-Non-Segmental-Vitiligo

2. Passeron T, Prajapati VH, Sivamani RK, et al. Efficacy and safety of upadacitinib in adults and adolescents for treatment of non-segmental vitiligo (Viti-Up): results of two phase 3 randomised controlled studies. Lancet. 2026;408(10555):636-648. doi:10.1016/S0140-6736(26)00896-2

3. Howard J, Fitzmaurice W, Boby A, Levin B, Silverberg N. Current management and emerging therapies for pediatric vitiligo: a narrative review. Paediatr Drugs. 2026;28(5):487-504. doi:10.1007/s40272-026-00767-0

4. Mendonça CR, Mohamed A, Mohamed A, Ferreira C, Torres T. New and emerging treatments for vitiligo: a narrative review. Expert Rev Clin Pharmacol. 2026;19(2):117-132. doi:10.1080/17512433.2026.2626458