Tofacitinib Citrate for Refractory Cutaneous Dermatomyositis

Abstract

Dermatomyositis is an uncommon autoimmune disorder with distinctive cutaneous manifestations that are frequently challenging to manage. Although a number of therapies including hydroxychloroquine, methotrexate, mycophenolate mofetil, and intravenous immunoglobulin have demonstrated efficacy, few alternative treatments are available when these agents fail. Recently, tofacitinib, an oral Janus kinase (JAK)-1/3 inhibitor, was approved for use in rheumatoid arthritis and has demonstrated efficacy for treating inflammatory skin diseases including psoriasis, alopecia areata, vitiligo, and atopic dermatitis. 1,2 Studies suggest that tofacitinib suppresses interferon signaling, 3 a pathway that has been found to be abnormally upregulated in dermatomyositis. 4 With this context in mind, we sought to evaluate the utility of tofacitinib for treating cutaneous dermatomyositis.

Tofacitinib citrate for the treatment of refractory, severe chronic actinic dermatitis

“…A case of refractory, severe CAD responded dramatically to tofacitinib, a JAK 1/3 inhibitor with activity in helper T cell 1– and helper T cell 2–mediated cutaneous diseases including psoriasis, 4 atopic dermatitis, 3 dermatomyositis, 5 and alopecia areata 6 . Although the pathogenesis of CAD remains unclear, there is evidence of a delayed-type hypersensitivity reaction to a photo-induced cutaneous endogenous antigen 2 …”

Anti‐Mi‐2 antibody‐positive inflammatory myopathy during treatment with golimumab

“…It inhibits type 1 interferon pathways, which may lead to the remission of the disease. Recently, several case reports show the effectiveness of tofacitinib in patients with dermatomyositis . Tofacitinib may be a candidate treatment option for TNF‐alpha inhibitor‐associated inflammatory myopathies.…”

JAK‐STAT signaling pathway inhibition: a role for treatment of discoid lupus erythematosus and dermatomyositis

“…Various cases have been reported where the use of JAK inhibitors, such as tofacitinib and ruxolitinib, resulted in positive outcomes for DM patients. Based on significant reduction in Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI) score among patients, the use of these medications was reported as being clinically effective . As described in Table , patients had improvements in both skin and muscle manifestations of the disease such as reduced pruritus and increased strength.…”

“…26 As illustrated in Figures 1 and 2 (CDASI) score among patients, the use of these medications was reported as being clinically effective. 30,31 As described in Table 2, patients had improvements in both skin and muscle manifestations of the disease such as reduced pruritus and increased strength. An additional study is currently recruiting patients to study the safety and efficacy of tofacitinib in adults with active, treatment-refractory dermatomyositis ( Table 3).…”