Efficacy and Safety of Non-steroidal Versus Steroidal Immunosuppressants in Vitiligo Treatment: A Systematic Review and Meta-analysis

Abstract

Vitiligo is an acquired chronic autoimmune depigmentation disorder, and mainstream treatment options for vitiligo are non-steroidal immunosuppressants/immunomodulators (NSIs) and steroidal immunosuppressants (SIs). However, there are variations in the efficacy and safety of NSIs and SIs in the management of vitiligo. This research aimed to compare the efficacy and safety of NSIs and SIs in the management of vitiligo. A systematic literature search was conducted using various electronic databases, including PubMed, Scopus, Web of Science, and Embase, up to June 2025. All randomized controlled trials (RCTs) and quasi-experimental studies were included in our review, involving participants with vitiligo who received either NSIs or SIs. Quality assessment of all included studies was performed using standardized risk-of-bias tools. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the identification number CRD42023443213. A total of 14 studies were included in our review. Our study did not show a significant result for the VASI score and we could not compare the efficacy of NSIs versus SIs based on re-pigmentation and VIDA due to insufficient data. Regarding the safety profile, both NSIs and SIs were well tolerated. However, NSIs were associated with lower weight gain ( p = 0.02).