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UVB Therapy in Vitiligo
Published in Vineet Relhan, Vijay Kumar Garg, Sneha Ghunawat, Khushbu Mahajan, Comprehensive Textbook on Vitiligo, 2020
Surabhi Dayal, Priyadarshini Sahu
Afamelanotide, a potent long-lasting synthetic analog of naturally occurring α-MSH (melanocyte stimulating hormone) when combined with NB-UVB results in clinically apparent earlier and superior repigmentary response [35,36].
Emerging treatments for vitiligo
Published in Electra Nicolaidou, Clio Dessinioti, Andreas D. Katsambas, Hypopigmentation, 2019
Angelo Massimiliano D'Erme, Giovanni Bagnoni
Afamelanotide, a synthetic analogue of alpha-melanocyte-stimulating hormone (α-MSH), has recently been approved by the European Medicines Agency to mitigate photosensitivity in erythropoietic protoporphyria. Afamelanotide also seems to improve the efficacy of NB-UVB in vitiligo. A randomized trial with afamelanotide in combination with NB-UVB was carried out in adults with generalized vitiligo. The addition of afamelanotide resulted in faster and increased total repigmentation compared to NB-UVB monotherapy, especially in patients with darker skin. The combination therapy was somewhat well tolerated, although side effects including nausea and skin hyperpigmentation were reported.20
Afamelanotide for prevention of phototoxicity in erythropoietic protoporphyria
Published in Expert Review of Clinical Pharmacology, 2021
Debby Wensink, Margreet A.E.M. Wagenmakers, Janneke G. Langendonk
Afamelanotide is a synthetic α-MSH analog. Afamelanotide chemically differs from α-MSH by substitution of the amino acids methionine and L-phenylalanine at positions 4 and 7 with norleucine and D-phenylalanine [Nle4-D-Phe7]-α-MSH. This manipulation of the stereo-chemical structure of α-MSH was performed in order to make afamelanotide more potent and prolong biological activity [54]. Afamelanotide works as an agonist on the MC1R, a G protein-coupled receptor that plays a key role in the biosynthesis of melanin. Binding of afamelanotide to MC1R activates eumelanogenesis, by increasing intracellular content of cyclic AMP (cAMP) and increasing tyrosinase activity, the rate-limiting step in melanogenesis [55]. Afamelanotide acts in the same way as endogenous MSH on MC1R, but independent of UV stimulation. Eumelanin exhibits numerous effects, including photo protection against ultraviolet (UV) light (by absorbing the UV light) and scavenging of free radicals [56].
Emerging drugs for the treatment of vitiligo
Published in Expert Opinion on Emerging Drugs, 2020
Priyanka Karagaiah, Yan Valle, Julia Sigova, Nicola Zerbinati, Petar Vojvodic, Davinder Parsad, Robert A. Schwartz, Stephan Grabbe, Mohamad Goldust, Torello Lotti
Afamelanotide [Nle4-D-Phe7]-α-MSH is a potent synthetic analogue of naturally occurring hormone alpha-melanocyte-stimulating hormone (α-MSH), with a greater affinity to the melanocortin 1 receptor (MC1R) and a longer half-life that can stimulate melanogenesis and facilitate the transfer of eumelanin within the melanosome. It may also restore balance in cytokine environment by acting on inflammatory cells expressing MC1R (neutrophils and lymphocytes). In a randomized comparative multicenter trial, 28 patients were randomized to combination therapy (Afamelanotide plus NB-UV-B) and 27 into monotherapy with NBUVB to test the safety and efficacy of afamelanotide subcutaneous implants in generalized vitiligo. After receiving NB-UV-B for 1 month, 16 mg of afamelanotide subcutaneous implants were administered monthly to the combination therapy group while the other group received NB-UV-B monotherapy. Afamelanotide combination therapy was found to be superior (48.64% repigmentation) to NB-UV-B monotherapy (33.26% repigmentation) (P < .05). Earlier and better results were observed in the face and upper extremities compared to the trunk and lower extremities and no response was seen in the feet. Nausea, erythema, and generalized skin hyperpigmentation were well-tolerated, although some subjects withdrew from the trial as the hyperpigmentation was socially unacceptable [97].
Safety of the current drug treatments for vitiligo
Published in Expert Opinion on Drug Safety, 2020
Torello Lotti, Komal Agarwal, Indrashis Podder, Francesca Satolli, Martin Kassir, Robert A Schwartz, Uwe Wollina, Stephan Grabbe, Alexander A Navarini, Simon M Mueller, Mohamad Goldust
Afamelanotide is an alpha melanocyte-stimulating hormone agonist analog, a regulatory protein that regulates melanogenesis and melanocyte proliferation. Afamelanotide is delivered as a subcutaneous implant, which roughly lasts for about 2 months [5]. Common adverse effects include nausea and headache, other adverse effects are hyperpigmentation of normal skin, back pain, upper respiratory tract infections, decreased appetite, migraine, dizziness, weakness, fatigue, lethargy, vomiting, flushing and red skin, development of warts and freckles, itchy skin, and reactions at the injection site. There are no data regarding safety and efficacy of afamelanotide in pregnancy, lactation, and children below 18 years of age [5].