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

Abstract

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 Previous treatments were GC, hydroxychloroquine, methotrexate, etanercept, withdrawn after ILD detection, and tocilizumab, discontinued due to relapsing infections.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.

Tofacitinib plus iguratimod for improving rheumatoid arthritis-related usual interstitial pneumonia: a three-case report and literature review

“…Kodera et al [17] described two cases with RA complicated by OP were successfully treated with tofacitinib therapy. Vacchi et al [18] reported successful treatment of severe ILD related to RA with tofacitinib.…”

“…In vitro and in vivo studies investigated tofacitinib in ILDs. These results collectively indicated that tofacitinib is a potential therapeutic option for RA-UIP [9][10][11][12]. Iguratimod (IGU), a small molecule with new anti-inflammatory and immunomodulatory properties, was developed as a novel anti-rheumatic drug and is widely used for RA.…”

Interstitial Pneumonia with Autoimmune Features: What the Rheumatologist Needs to Know

“…Rituximab and abatacept has shown promise in ILD, particularly in SSc [ 55 , 56 ]. Recently, tocilizumab has been approved for treatment of SSc-ILD [ 57 •• ]. Refractory IIM-ILD can be treated with calcineurin inhibitors and intravenous immune globulin (IVIG) [ 58 ].…”

Baricitinib and the Risk of Incident Interstitial Lung Disease: A Descriptive Clinical Case Report from Clinical Trials

“…Among biologic disease-modifying anti-rheumatic drugs (DMARDs) authorized for the treatment of RA, rituximab has shown some promising positive results in published case series of ILD associated to RA or other connective tissue diseases. A 10-year study showed that rituximab may inhibit the development and progression of ILD [ 7 , 8 ]. Also, abatacept in a national multicenter, non-controlled, open-label registry study appeared to be safe in RA-associated ILD [ 9 ].…”