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.