responded well to tofacitinib, progression of his interstitial lung disease led to discontinuation of the drug.
Complete blood counts and comprehensive metabolic panels were reviewed in all patients. Abnormal liver function tests and decreased hemoglobin were transiently observed in one patient. Lipid panels were available for review in 3 patients. Elevations in cholesterol were noted in 2 patients but did not require treatment. One patient experienced shingles at month 5 of treatment and a deep venous thrombosis (DVT) with pulmonary embolus at month 9 of treatment. The DVT was attributed to concurrent IVIG therapy and did not recur after discontinuing IVIG. No other adverse events were reported.
Topical and oral formulations of tofacitinib led to positive, sustained clinical improvement in dermatologic as well as systemic symptoms of DM. Stronger responses were observed in patients receiving higher doses of tofacitinib, a finding consistent with previous studies.4 One patient experienced a significant adverse event attributed to IVIG, but tofacitinib was otherwise well-tolerated with only minor laboratory abnormalities noted.
Limitations of this study include the small sample size, retrospective study design, adjunctive treatments, and lack of a widely accepted scoring method.4 In conclusion, this study supports oral and topical tofacitinib for the treatment of cutaneous and extracutaneous manifestations of refractory DM.
DISCLOSURES
The authors have declared no conflicts of interest and/or
support, financial interests, or patents.
REFERENCES
1. Moghadam-Kia S, Charlton D, Aggarwal R, Oddis CV. Management of refractory cutaneous dermatomyositis: potential role of Janus kinase inhibition with tofacitinib. Rheumatology (Oxford). 2019;58(6):1011â€1015. doi:10.1093/ rheumatology/key366
2. Shreberk-Hassidim R, Ramot Y, Zlotogorski A. Janus kinase inhibitors in dermatology: A systematic review. J Am Acad Dermatol. 2017;76(4):745â€753.e19. doi:10.1016/j.jaad.2016.12.004
3. Cinats A, Heck E, Robertson L. Janus Kinase Inhibitors: A review of their emerging applications in dermatology. Skin Therapy Lett. 2018;23(3):5-9. PMID: 29772037.
4. Kurtzman DJ, Wright NA, Lin J, et al. Tofacitinib citrate for refractory cutaneous dermatomyositis: an alternative treatment. JAMA Dermatol. 2016;152(8):944â€945. doi:10.1001/jamadermatol.2016.0866
5. Chen Z, Wang X, Ye S. Tofacitinib in amyopathic dermatomyositis-associated interstitial lung disease. N Engl J Med. 2019;381(3):291â€293. doi:10.1056/ NEJMc1900045
2. Shreberk-Hassidim R, Ramot Y, Zlotogorski A. Janus kinase inhibitors in dermatology: A systematic review. J Am Acad Dermatol. 2017;76(4):745â€753.e19. doi:10.1016/j.jaad.2016.12.004
3. Cinats A, Heck E, Robertson L. Janus Kinase Inhibitors: A review of their emerging applications in dermatology. Skin Therapy Lett. 2018;23(3):5-9. PMID: 29772037.
4. Kurtzman DJ, Wright NA, Lin J, et al. Tofacitinib citrate for refractory cutaneous dermatomyositis: an alternative treatment. JAMA Dermatol. 2016;152(8):944â€945. doi:10.1001/jamadermatol.2016.0866
5. Chen Z, Wang X, Ye S. Tofacitinib in amyopathic dermatomyositis-associated interstitial lung disease. N Engl J Med. 2019;381(3):291â€293. doi:10.1056/ NEJMc1900045
AUTHOR CORRESPONDENCE
John Plante MD MSCR jplan1992@yahoo.com
