EADV 2026: Tranquillo and evolving vitiligo care

Emerging systemic therapies and new phase 3 data shape the future of vitiligo treatment

Key takeaways:
· Three oral JAK inhibitors have now reported positive phase 3 results in vitiligo

· The INTERCEPT international consensus provides new guidance on patient selection for systemic treatment

· Ritlecitinib achieved F-VASI75 responses of 21.9% versus 2.4% with placebo in Tranquillo 2 Part Ia

· Approximately 75–77% of patients receiving ritlecitinib remained free from disease progression

Emerging therapies were a key focus of the vitiligo update session at the 35th European Academy of Dermatology and Venereology Congress (EADV 2026), where Viktoria Eleftheriadou (Walsall Healthcare & The Royal Wolverhampton NHS Trusts, Wolverhampton, UK) reviewed advances in systemic treatment for non-segmental vitiligo. Discussing the growing body of evidence for oral Janus kinase (JAK) inhibitors, she highlighted phase 3 programs evaluating upadacitinib, povorcitinib, and ritlecitinib – all of which have reported positive results.

Which patients are most likely to benefit from systemic therapy?

The emergence of multiple treatment options raises an important practical question for clinicians: which patients are most likely to benefit from systemic therapy? Eleftheriadou presented the recently published INTERCEPT international consensus, which proposes definitions of vitiligo severity and provides guidance on patient selection. The consensus recommends considering systemic treatment for patients with moderate-to-severe disease, those with rapidly progressive vitiligo regardless of body surface area involvement, and, where appropriate, patients whose disease has not responded to topical therapy.

About the Tranquillo program

Late-breaking results from the Tranquillo clinical program were subsequently presented by Iltefat Hamzavi (Henry Ford Hospital, Detroit, Michigan, USA), who reported findings from the phase 3 Tranquillo and Tranquillo 2 Part Ia studies. The studies enrolled 2,174 patients with non-segmental vitiligo across 271 sites worldwide and evaluated ritlecitinib at doses of 50 mg and 100 mg over 52 weeks.

How well did ritlecitinib work in the Tranquillo studies?

In Tranquillo 2 Part Ia, significantly more patients receiving ritlecitinib 100 mg achieved the co-primary endpoints of ≥75% improvement from baseline in the Facial Vitiligo Area Scoring Index (F-VASI75) and ≥50% improvement from baseline in the Total Vitiligo Area Scoring Index (T-VASI50) at week 52 than those receiving placebo (21.9% vs 2.4% and 13.0% vs 2.4%, respectively; both p<0.000001). In the Tranquillo study, significantly more patients receiving ritlecitinib 50 mg achieved F-VASI75 (12.5% vs 2.5%) and T-VASI50 (9.0% vs 2.0%) compared with placebo at week 52. Improvements in both facial and total-body repigmentation were observed as early as week 24 and continued through week 52. Patients receiving ritlecitinib also reported greater improvements in facial and overall vitiligo severity, with significantly higher Patient Global Impression of Severity–Face (PGIS-F) and Patient Global Impression of Severity–Vitiligo (PGIS-V) response rates at week 52 than those receiving placebo across both studies.

Disease stabilization also emerged as an important outcome. Approximately 75% and 77% of patients receiving ritlecitinib in Tranquillo and Tranquillo 2, respectively, remained free from disease progression, compared with around 60% of patients receiving placebo.

Is ritlecitinib well tolerated for vitiligo?

Safety was also evaluated across both phase 3 studies. In Tranquillo 2 Part Ia, treatment-emergent adverse events occurred in 67.7%, 60.0%, and 62.0% of patients receiving ritlecitinib 100 mg, ritlecitinib 50 mg, and placebo, respectively, while serious adverse events occurred in 3.4%, 2.9%, and 3.4% of patients. In the Tranquillo study, treatment-emergent adverse events occurred in 81.0% and 77.1% of patients receiving ritlecitinib 50 mg and placebo, respectively, while serious adverse events occurred in 2.0% and 2.5% of patients. The most commonly reported treatment-emergent adverse events across the program were upper respiratory tract infection, nasopharyngitis, headache, and increased blood creatine phosphokinase levels. No new safety signals were identified, and investigators concluded that the safety profile was consistent with previous ritlecitinib studies.

What do Tranquillo findings mean for vitiligo treatment?

The Tranquillo findings demonstrate the potential of ritlecitinib to improve facial and total-body repigmentation in patients with non-segmental vitiligo, while highlighting disease stabilization as an increasingly important treatment goal. Together, they reinforce the emerging role of targeted therapies in the management of vitiligo.

Frequently asked questions

What is ritlecitinib?

Ritlecitinib is an oral JAK3/TEC family kinase inhibitor being investigated as a systemic treatment for non-segmental vitiligo.

What were the Tranquillo studies?

Tranquillo and Tranquillo 2 Part Ia were phase 3, randomized, placebo-controlled studies in non-segmental vitiligo. Tranquillo evaluated ritlecitinib 50 mg versus placebo, while Tranquillo 2 Part Ia evaluated ritlecitinib 50 mg and 100 mg versus placebo over 52 weeks.

How long may ritlecitinib take to show an effect in vitiligo?

In the Tranquillo studies, ritlecitinib began to show an effect in vitiligo as early as week 24, with improvements in facial and total-body repigmentation continuing through week 52.