Original articleJanus kinase inhibition induces disease remission in cutaneous sarcoidosis and granuloma annulare
Graphical abstract
Section snippets
Patients
Patients were referred to a tertiary dermatology practice at an academic medical center (Yale, New Haven, CT). Patients had biopsy-proven, moderate to severe cutaneous sarcoidosis or generalized GA that was uncontrolled with other systemic medication and were offered treatment with tofacitinib (off label) after discussion of possible adverse effects. Patients provided verbal informed consent.
Histologic case series
Skin biopsy specimens were identified by searching the Yale dermatopathology database by diagnosis.
Tofacitinib induces clinical disease remission in patients with sarcoidosis and GA
Four consecutive patients, 3 with sarcoidosis (1 recently reported elsewhere19 and 2 additional patients) and 1 with generalized GA, were treated with tofacitinib 5 mg twice daily. The average age of the patients was 54 years, and the average disease duration was 11.25 years; patient characteristics are listed in Table I. Common therapies, including hydroxychloroquine, methotrexate, and adalimumab, among others, had failed for these patients.
An average improvement in baseline disease activity
Discussion
Cutaneous sarcoidosis and GA are difficult to treat, and there are no reliably effective therapies for these disorders, except prednisone. Here, we show the efficacy of the JAK1/3 inhibitor tofacitinib in a series of 4 patients with treatment-recalcitrant disease and expand the findings of our prior report of a single patient.19 Complete or near-complete clinical remission was observed in all patients, and histologic resolution of granulomatous inflammation was also seen. Clinical improvement
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Cited by (0)
Funding sources: Supported by a grant to Dr King from the Ranjini and Ajay Poddar Resource Fund for Dermatologic Diseases Research. Dr Damsky is supported by a Career Development Award from the Dermatology Foundation. Dr Thakral is supported by a Medical Science Training program grant (T32GM007205).
Disclosures: Dr Damsky has served as a consultant for Eli Lilly in unrelated work and is the recipient of investigator-initiated trial support from Pfizer; the latter award did not support the current study. Dr Leventhal served on an advisory board for Amgen in unrelated work. Dr King is an investigator for Concert Pharmaceuticals Inc, Eli Lilly and Company, and Pfizer Inc; is a consultant to and/or has served on advisory boards for Aclaris Therapeutics, Arena Pharmaceuticals, Concert Pharmaceuticals Inc, Dermavant Sciences, Eli Lilly and Company, and Pfizer Inc; and is on the speakers bureau for Pfizer Inc, Regeneron, and Sanofi Genzyme, all in unrelated work. Drs Thakral, Galan, and McGeary have no conflicts of interest to declare.
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