Successful dose escalation of tofacitinib for refractory dermatomyositis and interstitial lung disease with anti-melanoma differentiation-associated gene 5 antibodies

Ohmura, Shin-Ichiro; Yamabe, Toru; Naniwa, Taio

doi:10.1080/24725625.2020.1816674

Cited by 21 publications

(20 citation statements)

References 24 publications

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“…About the possible effect on ILD, some case reports have recently been published in which tofacitinib appears to be effective on ILD related to antimelanoma differentiation-November 2017 associated 5 gene antibody-positive dermatomyositis and antisynthetase syndrome [20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Tofacitinib for the Treatment of Severe Interstitial Lung Disease Related to Rheumatoid Arthritis

Vacchi

Manfredi

Cassone

et al. 2021

Case Reports in Medicine

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Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease characterized by chronic symmetrical erosive synovitis and extra-articular manifestations, including interstitial lung disease (ILD), whose treatment is nowadays challenging due to high infectious risk and possible pulmonary iatrogenic toxicity. Janus kinase inhibitors, namely, tofacitinib, baricitinib, and upadacitinib, are the latest drug class for the treatment of RA with a good safety profile. We present the case of a patient with RA-ILD successfully treated with tofacitinib. A 52-year-old man was referred to our multidisciplinary clinic for rheumatic and pulmonary diseases for an active erosive seropositive RA and progressive ILD. Previous treatments were GC, hydroxychloroquine, methotrexate, etanercept, withdrawn after ILD detection, and tocilizumab, discontinued due to relapsing infections. After our evaluation, we proposed rituximab in addition to low-dose GC and hydroxychloroquine, ineffective on joint involvement. Therefore, we proposed tofacitinib which allowed us to control joint involvement, stabilize ILD improving respiratory symptoms, and manage the frequent infectious episodes that occurred initially. The short half-life and rapid-acting of tofacitinib are two helpful characteristics regarding this aspect. Despite limited data from randomized trials and real-life, tofacitinib could represent a safe therapeutic option for RA-ILD patients. Longitudinal studies are required to confirm this encouraging report.

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Section: Discussionmentioning

confidence: 99%

Tofacitinib for the Treatment of Severe Interstitial Lung Disease Related to Rheumatoid Arthritis

Vacchi

Manfredi

Cassone

et al. 2021

Case Reports in Medicine

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“…14 In a study by Shin-ichiro Ohmura et al a higher dose of tofacitinib was administered which showed significant improvement in symptoms with minor complications of cytomegalovirus reactivation and skin infection. 24 As per the findings of this review, we can say that JAK-inhibitors could be a potentially curative treatment option for refractory DM. Since it has been successfully used for the treatment of other diseases like alopecia areata, vitiligo, SLE, psoriasis, graft-vs-host disease (GVHD), atopic dermatitis, and so forth.…”

Section: T a B L E 1 Studies Reporting The Use Of Jak-inhibitors For ...mentioning

confidence: 62%

“…Subsequently, the dose was increased to 20 mg daily which showed a remarkable response with the improvement of symptoms. Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI) score were significantly reduced to 0 from 15 24 . In a study by Kurtzman et al Tofacitinib used in higher doses showed significant improvement in CDASI score, facial rash, muscle strength, and fatigue without concomitant therapies 9 .…”

Section: Resultsmentioning

confidence: 99%

“…Two patients used AZA, 5 patients used MMF, 9 patients used MTX, and rituximab was used by 1 patient. One patient used a combination of PDN and tacrolimus 24 . Six studies including 11 patients did not report information about concomitant therapies.…”

Section: Resultsmentioning

confidence: 99%

“…Overall, 15 studies including 53 patients treated with JAK-inhibitor (tofacitinib or ruxolitinib) for refractory DM were identified during the literature search. [8][9][10][14][15][16][17][18][19][20][21][22][23][24][25][26][27] All the identified studies are given in Table 1. The age of the patients was reported in 15 studies and the age ranged from 30 to 84 years.…”

Section: Resultsmentioning

confidence: 99%

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JAK‐inhibitors for dermatomyositis: A concise literature review

Paudyal

Zheng

Lyu

et al. 2021

Dermatologic Therapy

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Refractory dermatomyositis (DM) is defined as cases that do not show improvement after initial treatment with two different immunosuppressives combined with corticosteroids with or without intravenous immunoglobulins. In recent years, few studies have reported a positive response to the use of Janus kinase inhibitors (JAK‐inhibitors) for the treatment of refractory DM. A systematic literature review was performed for articles studying the use of JAK‐inhibitors for the treatment of refractory DM. We identified 38 females and 15 males treated with JAK‐inhibitors without serious side effects. Tofacitinib was the most frequently used JAK‐inhibitor followed by ruxolitinib. Significant improvement in CDASI score, muscle strength, body weight, and skin lesions were reported in most of the studies. The duration of follow‐up ranged from 1 to 15 months without relapse. Therefore, the use of JAK‐inhibitors looks promising in the treatment of refractory DM and further high volume research may be required to validate the current concept. As only case reports and series were identified without direct comparison for review, there is a potential risk of bias. Despite these limitations, we believe that the result of this analysis allows a better understanding of treatment options for refractory DM and will help generate a hypothesis that can be further tested.

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Baricitinib for anti-melanoma differentiation-associated protein 5 antibody-positive dermatomyositis-associated interstitial lung disease: a case series and literature review on Janus kinase inhibitors for the disease

Harada,

Shoda,

Tsuchiya

et al. 2024

Rheumatol Int

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Anti-melanoma differentiation-associated protein 5 antibody-positive dermatomyositis (anti-MDA5-DM) is frequently complicated by progressive interstitial lung disease (ILD), the prognosis of which is poor, and management is a major challenge. We treated three patients with anti-MDA5-DM-associated ILD (anti-MDA5-DM-ILD) using the Janus kinase (JAK) inhibitor, baricitinib, which improved lung opacities and saved two patients. We reviewed 6 patients with anti-MDA5-DM-ILD who had been treated with tofacitinib at our institution. Five of the patients survived, although discontinuation of tofacitinib due to complications was frequently observed. In addition, a literature search of patients with anti-MDA5-DM-ILD who were treated with JAK inhibitors yielded 21 articles involving 79 cases. All patients except one were treated with tofacitinib, and the survival rate was 75.9%. Although not statistically confirmed, the deceased patients tended to be older and had higher ferritin levels. A total of 92 complications were observed, 11 of which resulted in JAK inhibitor discontinuation. Cytomegalovirus reactivation comprised a substantial percentage of all complications and of those patients who required JAK inhibitor discontinuation. Five cases with fatal infective complications were also observed. While tofacitinib has been proposed to be a therapeutic option for anti-MDA5-DM-ILD, other JAK inhibitors, including baricitinib, are a treatment option. Further investigation is warranted to optimize treatment of anti-MDA5-DM-ILD.

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Successful dose escalation of tofacitinib for refractory dermatomyositis and interstitial lung disease with anti-melanoma differentiation-associated gene 5 antibodies

Cited by 21 publications

References 24 publications

Tofacitinib for the Treatment of Severe Interstitial Lung Disease Related to Rheumatoid Arthritis

Tofacitinib for the Treatment of Severe Interstitial Lung Disease Related to Rheumatoid Arthritis

JAK‐inhibitors for dermatomyositis: A concise literature review

Baricitinib for anti-melanoma differentiation-associated protein 5 antibody-positive dermatomyositis-associated interstitial lung disease: a case series and literature review on Janus kinase inhibitors for the disease

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