Upadacitinib (Rinvoq, AbbVie) remained safe and efficacious through 76 weeks in patients with nonsegmental vitiligo (NSV), and a 28-week substudy showed that adding narrow-band UVB phototherapy further increased repigmentation on top of the JAK inhibitor alone.

Julien Seneschal, MD, PhD, professor of dermatology at the University of Bordeaux, France, presented the new results October 1 at the European Academy of Dermatology and Venereology (EADV) 2026 Congress in Vienna. The data come from the two ongoing pivotal phase 3 trials, Viti-Up-1 and Viti-Up-2, published in The Lancet.

"Facial and total body repigmentation efficacy rates continue to increase with upadacitinib treatment with and without narrow-band UVB over time with no new safety signals," Seneschal said. "Upadacitinib plus UV light further enhanced the efficacy of upadacitinib compared to upadacitinib monotherapy, regardless of preceding treatments."

Regulatory Context

The European Commission approved upadacitinib in July for adolescents and adults 12 years and older with NSV who are candidates for systemic therapy. The FDA is currently reviewing the application for the same indication.

Upadacitinib is a selective, once-daily JAK inhibitor. The trials enrolled a combined 614 patients with NSV involving the face and body, each with a Facial Vitiligo Scoring Index (F-VASI) of 0.5 or greater and a Total Vitiligo Area Scoring Index (T-VASI) of 5 to less than 50.

Viti-Up-1 randomized 308 patients (23 adolescents aged 12–17 years and 285 adults aged 18 or older), and Viti-Up-2 randomized 306 patients (30 adolescents and 276 adults). Patients received either upadacitinib 15 mg once daily (Viti-Up-1, n = 206; Viti-Up-2, n = 205) or placebo (Viti-Up-1, n = 102; Viti-Up-2, n = 101).

The co-primary efficacy endpoints — a 50% or greater reduction in T-VASI (T-VASI 50) and a 75% or greater reduction in F-VASI (F-VASI 75) from baseline at 48 weeks — were both met.

Gains Continue Beyond Week 48

The EADV presentation tracked patients out to 76 weeks. Response rates kept climbing without an apparent plateau, including in patients who switched from placebo to upadacitinib at week 48.

"For patient groups on upadacitinib and those switching from placebo to upadacitinib at week 48, increasing proportions achieved F-VASI 75 and T-VASI 50 through week 76 with no apparent plateau," Seneschal said.

In Viti-Up-1, 55.1% of patients achieved F-VASI 75 and 42.5% achieved T-VASI 50 at 76 weeks, up from 33.1% and 29.2%, respectively, at 48 weeks. In Viti-Up-2, 47.4% achieved F-VASI 75 and 40.1% achieved T-VASI 50 at 76 weeks, compared with 27.6% and 26.2% at 48 weeks.

Phototherapy Substudy

The investigators also reported a substudy in 84 patients from both trials who failed to reach T-VASI 90 at week 48 but met all other eligibility criteria. Participants continued upadacitinib alone or added whole-body narrow-band UVB phototherapy administered twice weekly for approximately 28 weeks.

The proportion achieving F-VASI 75 increased in all groups, with greater improvement in the combination arm. Whole-body results followed the same pattern.

"When you look at the whole body regarding the T-VASI 50, across 28 weeks the proportion of patients achieving T-VASI 50 increased across all treatment groups, both in the combination therapy and upadacitinib monotherapy," Seneschal noted. "But you can see numerically greater increases in efficacy in patients receiving upadacitinib plus narrow-band UV light, with 63% reaching T-VASI 50."

The investigators said the results justify further research into the combination approach.

The Access Question

Session moderator Marie-Aleth Richard, MD, head of the department of dermatology at Hospital de la Timone, Marseille, France, questioned how many patients could realistically obtain the combination.

"Even if you demonstrate clearly that something is better when you have a synergy between the combination upadacitinib and the phototherapy, beyond this, how many patients could have the access to the UV devices and to the UV cabins across Europe, or across the world at this time? In my opinion, this is something which is difficult to achieve," she said.

Seneschal pointed to natural sunlight and home phototherapy as more available and affordable options. "It could be also natural sun exposure, but it depends where you live, first," he said. "And in France, and now in some other countries, there is the possibility to do home phototherapy that show very good results."

AbbVie funded the trials. Seneschal's disclosures include grants and/or honoraria from AbbVie, Almirall, Boehringer Ingelheim, Incyte, LEO Pharma, Lilly, Novartis, Pfizer, Pierre Fabre, Sanofi, and Silab.

With the 76-week efficacy curve still rising and the FDA decision pending, longer-term Viti-Up follow-up and formal testing of the phototherapy combination will shape how systemic vitiligo therapy is sequenced in practice.