托法替布治疗白癜风患者的疗效分析

Analysis of the Efficacy of Tofacitinib in the Treatment of Patients with Vitiligo

摘要: 目的：评估托法替布对常规治疗不佳的白癜风患者的疗效、影响因素及安全性。方法：收集2023年8月~2025年8月在安徽医科大学第二附属医院就诊的、对传统治疗应答不佳的成人非节段型难治性白癜风患者，记录患者基线资料，比较其治疗初始、3个月、6个月的总白癜风面积评分指数(VASI)、总VASI改善率、各部位VASI评分差异，分析疗效及其动态性、可能的影响因素及安全性。结果：总VASI评分随时间显著改善(P < 0.05)，各时间点两两比较均有统计学意义(均P = 0.003)，总改善率在3、6个月差异显著(P = 0.01)。广义线性混合模型分析显示疗效存在显著部位异质性(交互作用P = 0.018)。至治疗6个月，面颈部改善率(92.3%)显著高于其它部位(28.9%~50.0%)。疗效动力学分析显示，患者早期与后期月均改善量无统计学差异(P = 0.754)，但两者呈显著强正相关(ρ = 0.777, P = 0.001)。性别、年龄及病程对疗效无显著影响。5例(31.25%)出现轻度不良事件。结论：托法替布对常规治疗不佳的白癜风患者总体有效且安全，疗效随疗程延长而持续，并存在部位差异性。个体早期改善速度与后期速度强相关的发现提示，治疗第3个月可能具有疗效预测价值，为临床个体化管理提供了新思路。

Abstract: Objective: To evaluate the efficacy, influencing factors and safety of tofacitinib in vitiligo patients with poor conventional treatment. Methods: The adult patients with non-segmental refractory viti-ligo who were treated in the Second Affiliated Hospital of Anhui Medical University from August 2023 to August 2025 and did not respond well to traditional treatment were collected. The baseline data of the patients were recorded. The total vitiligo area score index (VASI), improvement rate and VASI score of each part were compared after 3 months and 6 months of treatment. The efficacy and its dynamics, possible influencing factors and safety were analyzed. Results: The total VASI score showed a significant time-dependent improvement (P < 0.05), and pairwise comparisons at each time point all achieved statistical significance (all P = 0.003). The overall improvement rate differed significantly at the 3- and 6-month follow-ups (P = 0.01). Generalized linear mixed model analysis revealed significant site heterogeneity in treatment efficacy (interaction P = 0.018). At the 6-month follow-up, the improvement rate of the face and neck region (92.3%) was markedly higher than that of other sites (28.9%~50.0%). Efficacy kinetic analysis demonstrated no significant difference in the mean monthly improvement between the early and late treatment phases (P = 0.754), whereas a significant strong positive correlation was observed between these two phases (ρ = 0.777, P = 0.001). Baseline factors including gender, age, and disease duration exhibited no significant impact on treatment efficacy. Mild adverse events were reported in 5 patients, accounting for 31.25% of the total cohort. Conclusion: Tofacitinib is generally effective and safe for vitiligo patients with re-fractory conventional treatment. Efficacy is sustained with prolonged treatment duration and ex-hibits site-specific heterogeneity. The strong positive correlation between early and late monthly improvement rates in individual patients suggests that the 3rd month of treatment may serve as a valuable predictive marker for therapeutic response, thereby providing novel insights for clinical personalized management.