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Upadacitinib demonstrates strong agreement between VASI and VES scores, effectively tracking vitiligo severity over 52 weeks.
A phase 2 clinical trial evaluating upadacitinib (UPA) in patients with non-segmental vitiligo (NSV) has demonstrated a strong and sustained agreement between two validated disease-assessment tools—the vitiligo area scoring index (VASI) and the vitiligo extent score (VES)—over a 52-week treatment period.
NSV is an autoimmune depigmenting disorder marked by the progressive loss of melanocytes, resulting in patchy skin depigmentation. Accurate measurement of disease extent is critical in clinical trials, with total VASI (T-VASI) traditionally employed to estimate the percentage of affected body surface area. VES, a newer and more user-friendly instrument, employs standardized visual templates to grade vitiligo severity and extent.
In this study, investigators explored the safety and efficacy of once-daily oral upadacitinib, a selective Janus kinase (JAK) inhibitor approved for multiple immune-mediated dermatologic conditions, using both T-VASI and total VES scores at week 24 and week 52. Results showed an excellent correlation between total VES and T-VASI scores at both evaluation points. At week 24, the correlation was highly significant (Pearson R=0.94) and remained equally strong at week 52 (R=0.94).
This close alignment was consistent across all treatment groups. At week 24, correlation coefficients were R=0.92 for placebo, R=0.95 for UPA 11 mg, and R=0.92 for UPA 22 mg. At week 52, correlations ranged from R=0.84 to R=0.96, irrespective of dose or prior placebo exposure. The agreement between VES and VASI was also maintained across fitzpatrick skin types (FST). At week 24, strong correlations were noted in both FST 1–3 (R up to 0.96) and FST 4–6 (R up to 0.98).
Similar consistency persisted at week 52, with correlation values reaching 0.99 in certain treatment subgroups, confirming reliability across diverse pigmentation backgrounds. These findings indicate that VES and VASI provide comparable and reliable assessments of vitiligo extent and severity over long-term treatment. Both tools successfully capture disease status and treatment response, supporting their usage as valid outcome measures in clinical trials examining upadacitinib and other emerging therapies for NSV. Overall, the study reinforces the clinical utility of VES as a practical alternative to VASI for monitoring treatment outcomes in NSV over 52 weeks.
Journal of the American Academy of Dermatology
65022 Correlation of VES and VASI scores in NSV patients treated with Upadacitinib at 24 and 52 weeks
Nanja van Geel et al.
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