Real-World Vitiligo Data Reveal High Discontinuation, Low Persistence Across Therapies

Despite a meaningful expansion in therapeutic options for vitiligo over the past several years, a substantial proportion of patients may not be receiving treatment, according to a real-world analysis presented at the 2026 American Academy of Dermatology (AAD) Annual Meeting in Denver, Colorado.¹

The retrospective cohort study, led by David Rosmarin, MD, of Indiana University School of Medicine, used data from the Merative MarketScan Commercial database spanning January 2016 through April 2025. Of 13,224 patients who met eligibility criteria after a new vitiligo diagnosis by a dermatologist, 6183 (46.8%) did not receive treatment during their follow-up period.

What Treated Patients Were Prescribed

Among the 7041 patients who did initiate therapy, traditional topical agents remained the predominant first-line approach. Topical corticosteroids were the most commonly initiated treatment (38.7%), followed by topical calcineurin inhibitors (29.4%), and the combination of both (13.3%).

Ruxolitinib (Opzelura; Incyte), the topical JAK1/JAK2 inhibitor approved by the FDA for vitiligo in 2022, accounted for 7.5% of first-line therapies across the full study period, but its uptake has accelerated since approval, rising from 16.0% of first-line prescriptions in 2022 to 35.7% in 2024. As ruxolitinib's share grew, the proportion of patients starting most other therapies declined correspondingly.

Persistence Remains a Challenge

According to Rosmarin et al, among patients who did receive treatment, adherence was low and declined over time. At 3 months, the mean proportion of days covered ranged from 16% for oral dexamethasone to 53% for ruxolitinib. By 12 months, those figures dropped further across all agents: topical corticosteroids (10%), topical calcineurin inhibitors (11%), the combination (14%), ruxolitinib (26%), and oral dexamethasone (5%).

Discontinuation and switching rates were similar to adherence. At 12 months, nearly all patients had discontinued or switched their initial therapy, defined based on claims-derived refill thresholds: topical corticosteroids (99.8%), oral dexamethasone (100%), the topical combination (97.4%), topical calcineurin inhibitors (82.4%), and ruxolitinib (86.8%).

Second-fill rates were low overall, with fewer than one-third of patients receiving a refill for most topical therapies within 1 year; ruxolitinib demonstrated the highest rate at 57.9%.

Treatment escalation to oral dexamethasone was rare regardless of initial therapy, occurring in fewer than 2% of patients across all first-line treatment groups at 12 months.

“Repigmentation in vitiligo requires time, yet many patients discontinue or switch therapy after only a few months. Dermatologists play a critical role in setting expectations and reinforcing persistence, as meaningful responses are often achievable with sustained treatment,” Rosmarin told Dermatology Times.

Clinical Implications

The authors concluded that the data point to an ongoing unmet need. The high rates of discontinuation and low refill behavior across all existing therapies highlight challenges with treatment continuation in real-world practice.

The findings should be interpreted in the context of claims-based analyses, which do not capture disease severity, body surface area involvement, over-the-counter treatments, or reasons for discontinuation.

“Despite the evolution in treatment patterns and the availability of newer therapies, nearly half of patients diagnosed with vitiligo were not receiving treatment. Of those who did receive treatment, rates of treatment discontinuation/switching were high, and second fill rates were low, indicating poor treatment persistence. There is a need for therapies for vitiligo that offer durable disease control and sustained treatment response,” Rosmarin et al concluded.

The data also provide context for the phase 3 Viti-Up results for upadacitinib presented separately at AAD 2026, where progressive repigmentation continued to build through 48 weeks without plateau.²

For more from AAD 2026, click here.

References

1. Rosmarin D, Hanson K, Soliman A, Elbuluk N. Real-world treatment patterns and persistence following vitiligo diagnosis in the US. Presented at: 2026 American Academy of Dermatology Annual Meeting; March 27-31, 2026; Denver, CO.
2. Passeron T, Prajapati V, Sivamani R, et al. Efficacy and safety of upadacitinib in adolescents and adults for treatment of non-segmental vitiligo: results of two phase 3 studies (Viti-Up). Presented at: 2026 American Academy of Dermatology Annual Meeting; March 27-31, 2026; Denver, CO.