Clinical and pathogenetic justification of the use of azathioprine in the treatment of progressive non-segmental vitiligo

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Abstract

BACKGROUND: Vitiligo refers to acquired hypomelanosis, characterized by the appearance of depigmented spots on the skin. The search for new vitiligo treatment approaches, which would simultaneously have a pathogenetic focus on the therapy of this disease and at the same time have a safe spectrum of side effects, is relevant today.

AIM: to evaluate the clinical and laboratory efficacy of azathioprine in progressive non-segmental vitiligo compared with NB-UVB monotherapy.

MATERIALS AND METHODS: 60 patients with progressive non-segmental vitiligo were divided into 2 equal groups: group 1 received azathioprine in combination with NB-UVB, group 2 received NB-UVB monotherapy. The follow-up period was 6 months. The effectiveness of therapy was evaluated based on the dynamics of the Vitiligo Area Scoring Index (VASI), dermatological quality of life index (DLQI), as well as the titers of proinflammatory cytokines IL-1ß, IL-2, IL-6, IL-8, IFN-γ, TNF-α and S100 protein in serum blood.

RESULTS: In the azathioprine + NB-UVB group, compared with the control group, a statistically significant prevalence of VASI and DLQI indices reduction was observed. (Me -61.70%, Q1–Q3: -75.14…-47.08%, p <0.001; Me -55.83%, Q1–Q3: -67.80…-40.29%, p <0.001). The dependence of the quality of life of patients on the prevalence of the skin process was noted (p <0.001). There was a statistically significant relationship between the activity of the skin process and the S100 protein in the blood serum of patients with vitiligo. (p <0.05) In addition, the analysis of the dynamics of immunological parameters of the main group compared with the control group showed a more significant decrease in the level of cytokines, as well as S100 protein in blood serum (p <0.001).

CONCLUSION: The combination of azathioprine and NB-UVB is effective and safe, helps to stabilize the skin process and stimulate the repigmentation of foci, significantly improving the quality of life of patients, contributes to the normalization of immunological parameters, leading to an earlier stop of the progression of the skin process.

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Kseniia A. Vovdenko

I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)

Author for correspondence.
Email: vovdenkoksenia@ya.ru
ORCID iD: 0000-0003-1415-3940
SPIN-code: 8315-2175

Graduate Student

Russian Federation, Moscow

Olga Yu. Olisova

I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)

Email: olisovaolga@mail.ru
ORCID iD: 0000-0003-2482-1754
SPIN-code: 2500-7989

MD, Dr. Sci. (Med.), Professor, Corresponding member of the Russian Academy of Sciences

Russian Federation, Moscow

Konstantin V. Smirnov

I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)

Email: puva3@mail.ru
ORCID iD: 0000-0001-7660-7958
SPIN-code: 2054-1086

MD, Cand. Sci. (Med.)

Russian Federation, Moscow

Daria A. Svistunova

Saratov State Medical University named after V.I. Razumovsky

Email: svistunova@mail.ru
ORCID iD: 0009-0004-4268-8824

MD, Cand. Sci. (Med.)

Russian Federation, Saratov

Konstantin M. Lomonosov

I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)

Email: lamclinic@yandex.ru
ORCID iD: 0000-0002-4580-6193
SPIN-code: 4784-9730

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

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Supplementary files

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2. Fig. 1. A graph of the regression function characterizing the dependence of DLQI on VASI after treatment. Note: ДИКЖ ― Dermatology life quality index (DLQI); VASI ― Vitiligo area scoring index.

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3. Fig. 2. The results of azathioprine therapy in combination with NB-UVB: а ― before treatment; b ― after 6 months of therapy.

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4. Fig. 3. The results of azathioprine therapy in combination with NB-UVB: а ― before treatment; b ― after 6 months of therapy.

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Copyright (c) 2023 Vovdenko K.A., Olisova O.Y., Smirnov K.V., Svistunova D.A., Lomonosov K.M.

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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ЭЛ № ФС 77 - 80653 от 15.03.2021 г.


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