Tofacitinib, useful option for the treatment of pyoderma gangrenosum in an ulcerative colitis patient

Olavarría, Pablo Salmón; Iturria, Saioa Rubio; Castillejo, Óscar Nantes

doi:10.17235/reed.2021.7977/2021

Cited by 7 publications

(4 citation statements)

References 4 publications

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“…Several small studies suggest tofacitinib may be effective for PG. [4][5][6] Historically, combination therapies for CD have been used; for example, azathioprine in combination with infliximab is more effective than azathioprine or infliximab alone. 7 A trial evaluating natalizumab in combination with infliximab suggested a trend towards better efficacy compared with infliximab alone.…”

Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of Tofacitinib in Combination With Biologic Therapy for Refractory Crohn’s Disease

Lee

Singla

Harper

et al. 2021

Inflammatory Bowel Diseases

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Background The majority of patients with Crohn’s disease (CD) will not achieve endoscopic remission on current therapy. Addition of tofacitinib to biologics may improve remission rates. Methods We retrospectively assessed safety and clinical and endoscopic effectiveness of off-label tofacitinib and biologics for CD. Results We identified 19 patients treated with tofacitinib and a biologic for refractory CD between 2017 and 2019. Tofacitinib was added for luminal disease on colonoscopy (n = 13), luminal disease on capsule (n = 3), and pyoderma gangrenosum (n = 3). The mean age was 41.2 years (28–62), mean disease was duration 16.9 years (6–36), and prior exposure to biologics was a median of 4 (1–6). Mean treatment duration was 9.6 months (SD, 3.3). Adverse events (AEs) were reported in 36.8% of patients, most commonly minor infection or CD flare, and no patients had a serious AE; 80.0% (n = 8) achieved clinical response, and 60.0% (n = 6) achieved clinical remission based on Harvey-Bradshaw Index. Endoscopic improvement occurred in 54.5% (n = 6), endoscopic remission in 18.2% (n = 2), and endoscopic healing in 18.2% (n = 2) of patients. Mean Simple Endoscopic Score in CD significantly improved from 13.6 ± 5.2 to 6.5 ± 4.0 after treatment (P < .01). Conclusions In patients treated with tofacitinib in combination with a biologic, no new safety signals were observed. Combination tofacitinib and a biologic was effective in achieving clinical and endoscopic improvement in some patients with severe, refractory CD, although a larger sample size is needed to further assess the efficacy and long-term safety of this treatment strategy.

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Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of Tofacitinib in Combination With Biologic Therapy for Refractory Crohn’s Disease

Lee

Singla

Harper

et al. 2021

Inflammatory Bowel Diseases

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“…Alone in 2021 eight new PG cases treated with these drugs appeared in the literature. Reports came from countries as far as Spain, 9 Russia/USA, 10 and Canada. 11 The two first reports on PG treated with baricitinib came from Brazil, and the third one is reported in the present paper.…”

Section: Discussionmentioning

confidence: 99%

JAK inhibitors: a novel, safe, and efficacious therapy for pyoderma gangrenosum

Castro

2023

Int J Dermatology

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Background Pyoderma gangrenosum currently lacks standardized therapy. New safer and more efficacious therapies are welcome. Aims To present two new PG cases treated with JAK inhibitors, adding to the small existing experience Methods & Methods Two case reports of PG patients successfully treated with tofacitinib and baricitinib. Results Both patients were cured and presented no relapse. Patient # 1 used baricitinib 2 mg bid for 39 days while patient # 2 was treated with tofacitinib 5 mg bid for 120 days. No adverse reactions were seen. Discussion The increasing usage of JAKi to treat inflammatory diseases had a positive reflex on PG therapy. Fifteen PG cases treated with these drugs had been found in literature and the two new cases here described add to the limited existing experience. Conclusion This is a novel use of tofacitinib and baricitinib beyond the approved indications. JAKi are a welcome addition to our options to manage patients with PG.

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“…Soon after, it was also approved for psoriatic arthritis (PsA), ankylosing spondylitis (AS), ulcerative colitis (UC), and polyarticular juvenile idiopathic arthritis [ 7 ]. The drug has been under investigation as an immunosuppressor for solid organ transplantation [ 8 ], and recently, it has been suggested for use in immunomodulated dermatological diseases, such as Pyoderma gangrenosum [ 9 , 10 , 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Cancer Risk in Patients Treated with the JAK Inhibitor Tofacitinib: Systematic Review and Meta-Analysis

Bezzio¹,

Vernero

Ribaldone

et al. 2023

Cancers

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Tofacitinib is approved for several immune-mediated inflammatory diseases, but safety concerns have recently been raised. We searched PubMed (accessed on 27 February 2023) for original articles regarding tofacitinib’s cancer risk when used for rheumatoid arthritis, ulcerative colitis, Crohn’s disease, psoriatic arthritis, and ankylosing spondylitis. Of the 2047 initial records, 22 articles describing 26 controlled studies (including 22 randomized controlled trials) were selected. In the comparison between tofacitinib and any control treatment, the relative risk (RR) for any cancer was 1.06 (95% CI, 0.86–1.31; p = 0.95). In separate comparisons between tofacitinib and either a placebo or biological therapy, no difference was found in the overall cancer risk (vs. placebo, RR = 1.04; 95% CI, 0.44–2.48; p = 0.95; vs. biological drugs, RR = 1.06; 95% CI, 0.86–1.31; p = 0.58). When tofacitinib was compared to tumor necrosis factor (TNF) inhibitors, the overall cancer RR was 1.40 (95% CI, 1.06–2.08; p = 0.02). Similarly, significant results were obtained for all cancers, except for non-melanoma skin cancer (RR = 1.47; 95% CI, 1.05–2.06; p = 0.03), and for this skin cancer alone (RR = 1.30; 95% CI, 0.22–5.83; p = 0.88). In conclusion, no difference in the overall cancer risk was found between tofacitinib and either a placebo or biological drugs, while a slightly higher risk was found in patients treated with tofacitinib than anti-TNF agents. Further studies are needed to better define the cancer risk of tofacitinib therapy.

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Tofacitinib, useful option for the treatment of pyoderma gangrenosum in an ulcerative colitis patient

Cited by 7 publications

References 4 publications

Safety and Efficacy of Tofacitinib in Combination With Biologic Therapy for Refractory Crohn’s Disease

Safety and Efficacy of Tofacitinib in Combination With Biologic Therapy for Refractory Crohn’s Disease

JAK inhibitors: a novel, safe, and efficacious therapy for pyoderma gangrenosum

Cancer Risk in Patients Treated with the JAK Inhibitor Tofacitinib: Systematic Review and Meta-Analysis

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