New study finds tofacitinib effective and affordable for refractory atopic dermatitis

New Delhi: New Delhi:
Tofacitinib
, a Janus kinase (JAK) inhibitor drug, used either as a standalone treatment or alongside other drugs to address moderate to severe cases of rheumatoid arthritis and ankylosing spondylitis, demonstrates effectiveness in managing
refractory atopic dermatitis
(AD).
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This was revealed in a study published in the Indian Dermatology online journal.
Atopic dermatitis (AD) presents as a long-term, recurring inflammatory disorder of the skin, and its characteristic itching significantly affects patients' daily living standards. The research was conducted at the department of dermatology, venereology and leprosy in Atal Bihari Vajpayee Institute of Medical Sciences and Research Institute and Dr Ram Manohar Lohia Hospital.
The results established that people who previously showed no response to standard systemic treatments, including oral corticosteroids, cyclosporine and azathioprine, exhibited significant
clinical improvement
when administered tofacitinib exclusively. The progress was evaluated through decreased Scoring Atopic Dermatitis (SCORAD), Eczema Area and Severity Index (EASI), and Numerical Rating Scale (NRS) measurements at 4-week and 8-week intervals.
The principal investigator of the study and dermatologist at RML Hospital, professor Kabir Sardana, explained that their main goal was to evaluate how well tofacitinib worked and its side effects in patients with difficult-to-treat moderate-to-severe AD. Additionally, they aimed to analyse the treatment costs between tofacitinib and dupilumab (approved by the Central Drugs Standard Control Organisation, India) for moderate and severe AD cases.
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The research indicated an average disease duration of three years. Patients displayed moderate to severe pruritus, excoriations, erythema, oozing and crusting. All participants had previously experienced treatment failure or intolerance to systemic therapy; 50% of patients also had other atopic conditions and bronchial asthma.
The researchers continued treatment with topical corticosteroids, moisturiser and topical calcineurin inhibitors alongside tofacitinib.
Improvements were observed in pruritus, sleep quality, affected body surface area, erythema, excoriation, papulation/edema and lichenification, with notable severity score reductions at four weeks and eight weeks of therapy.
Dr Sardana said that EASI 90 was attained by 66% of patients within 8 weeks, with one patient experiencing treatment failure. Patients achieved complete or near-complete disease resolution in an average of 6.1 weeks (ranging from 3-8 weeks).
Disease recurrence was observed in 36.3% of patients. Adverse reactions occurred in 41.6% of patients, including herpes zoster, dyslipidemia, anaemia, impetigo, and thrombocytosis.
The financial comparison revealed that dupilumab (a monoclonal antibody used to treat various allergic conditions, including atopic dermatitis, asthma, and nasal polyps) therapy costs 122 times more than tofacitinib treatment over an 8-week period.

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