Comorbidities and disease states associated with vitiligo are explored by a panel of key opinion leaders.
Jeffrey D. Dunn, PharmD, MBA: Dr King, you touched on this, but let’s take a deeper dive into this as we’re trying to establish the clinical consequences of vitiligo. What other comorbidities are associated with vitiligo? Is there causality? For example, if someone has vitiligo, are they more likely to have a worse something else?
Brett King, MD, PhD: That’s a great question. The first comorbidity that comes to mind is autoimmune thyroid disease, which is very well documented and common in patients with vitiligo. You mentioned causality. This is interesting. There’s often a lot of confusion by health care providers in particular that because of the association with autoimmune thyroid disease—let’s imagine a patient has Hashimoto thyroiditis—if I give them levothyroxine, their vitiligo is going to get better, as if the underactive or underperforming thyroid were somehow the master switch driving other autoimmune disease. That isn’t true. When a patient gets levothyroxine, their vitiligo doesn’t go away. These are associations.
The comorbidities are disease associations, ultimately driven by underlying genetics that overlap in these different disease states. Autoimmune thyroid disease isn’t common, but we see more of other autoimmune skin diseases in our patients with vitiligo. Not infrequently, we see associated atopic dermatitis; eczema; alopecia areata, an autoimmune form of hair loss; or other forms of autoimmune or inflammatory skin disease.
One thing that’s compelling and important messaging for payers is that giving somebody levothyroxine doesn’t make their vitiligo better, but these patients with other associated autoimmune disease, eczema, or atopic dermatitis, respond to JAK inhibitors. JAK inhibitors are the emerging therapy for vitiligo. A JAK inhibitor has been approved for alopecia areata, so in the payer decision-making algorithm, some thought should be given to it. If there’s an opportunity to make more than 1 disease better, there’s value there. I don’t know how you incorporate that into your decision-making, but that concept should be given some consideration.
The burden is on us as providers. We can’t be just living in our silo and saying, “I’m going to treat your vitiligo with X. I’m not going to consider your inflammatory arthritis and how that’s being treated by your other doctor.” Instead, it would be nice for 2 health care providers to come together and say, “There’s overlap in treatment of your disease and my disease, so can we bring a single treatment to bear on this patient and minimize everybody’s burden?”
David Epstein, MD, MBA: That’s the huge need out there. That’s No. 1.
Jeffrey D. Dunn, PharmD, MBA: That’s awesome. Intuitively, and maybe in an oversimplified way, understanding that this is an autoimmune disease state infers that if we treat it and address it, we’re maybe going to have some of these other benefits in other related disease states that could be comorbidities. Is there a better way to approach that?
It’s going to shine a different light on this disease state, and that’s going to be the challenge. It would be nice to have data showing that if we treat vitiligo, there’s less need for other expensive therapies to treat things like atopic dermatitis or psoriasis. It’s a big ask, but that kind of data would be important.
Transcript edited for clarity.
Clinical Characteristics, Outcomes of Patients With Plaque Psoriasis on Tapinarof Cream
December 5th 2023Two posters presented at the 2023 Fall Clinical Dermatology Conference examined patient demographics, clinical characteristics, and outcomes in patients with plaque psoriasis treated with tapinerof cream.
Read More
Understanding the Unmet Need for Therapies to Treat Rare Bile Duct Cancer
May 24th 2022On this episode of Managed Care Cast, we bring you an excerpt of an interview with a co-chair of the 2022 Cholangiocarcinoma Foundation (CCF) annual conference, held earlier this year, about the significant unmet therapy needs facing most patients with this rare cancer.
Listen
Imetelstat Offers Benefits for Patients With MDS Who Are Red Blood Cell–Transfusion Dependent
December 5th 2023The past year has offered new hope for patients with lower-risk myelodysplastic syndromes. Besides imetelstat, which has an FDA deadline for action of June 2024, the agency approved luspatercept, which has a different mechanism of action.
Read More