Dhar Sandipan, De Abhishek, Sarda Aarti, Godse Kiran, Lahiri Koushik
From the Department of Pediatric Dermatology, Institute of Child Health, Kolkata, West Bengal, India.
Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, India.
Indian J Dermatol. 2024 Jul-Aug;69(4):292-295. doi: 10.4103/ijd.ijd_843_22. Epub 2024 Aug 19.
Atopic dermatitis (AD) has a complex etiology that includes Th2 polarization, which is accompanied by the cytokines IL4, IL-5, IL-13, and IL-31, as well as Th17 and Th22, and in chronic lesions, Th1 cells. Tofacitinib inhibits Th1-, Th2-, and Th17-associated cytokines by selectively blocking JAK1 and JAK3 receptors. We conducted a multicentric, retrospective chart analysis to study the efficacy and safety of tofacitinib in patients with moderate to severe refractory AD.
We included 16 adult patients (aged >18 years) with moderate to severe AD who had previously undergone systemic therapy with inadequate response. In the baseline, demographic data, previous treatment history, severity scores (eczema area and severity index [EASI] and SCORing Atopic Dermatitis [SCORAD]), and quality of life score (Dermatology Life Quality Index [DLQI]) were noted. Baseline blood investigations, including complete blood count, liver function test, renal function test, lipid profile, and interferon gamma release assay for tuberculosis, were done. Patients were followed up every month for 6 months that included documentation of severity scores, blood investigations, and DLQI. Any adverse events, if reported, were noted.
All 16 patients completed the 6-month trial. Our patients were previously treated with cyclosporine (n = 10), methotrexate (n = 3), or both (n = 3). The mean EASI scores improved from 23.38 ± 9.56 at baseline to 8.50 ± 7.57 at the end of 6 months. The mean SCORAD score improved from 41.25 ± 8.69 at baseline to 14.93 ± 7.82 at the end of 6 months. Quality of life also improved as the mean DLQI improved from 15.18 ± 2.73 at baseline to 5.31 ± 4.11 at the end of the study period. No severe adverse reactions were noted, but 3 patients experienced dyslipidemia and 2 patients had altered bleeding time.
Tofacitinib is a safe and effective treatment option for recalcitrant moderate to severe adult AD.
特应性皮炎（AD）病因复杂，包括Th2极化，伴有细胞因子IL4、IL-5、IL-13和IL-31，以及Th17和Th22，在慢性皮损中还有Th1细胞。托法替布通过选择性阻断JAK1和JAK3受体来抑制与Th1、Th2和Th17相关的细胞因子。我们进行了一项多中心回顾性病历分析，以研究托法替布治疗中度至重度难治性AD患者的疗效和安全性。
我们纳入了16例成年患者（年龄>18岁），这些患者患有中度至重度AD，之前接受过全身治疗但疗效不佳。在基线时，记录人口统计学数据、既往治疗史、严重程度评分（湿疹面积和严重程度指数[EASI]以及特应性皮炎评分[SCORAD]）和生活质量评分（皮肤病生活质量指数[DLQI]）。进行了基线血液检查，包括全血细胞计数、肝功能检查、肾功能检查、血脂谱以及结核菌素γ释放试验。患者每月随访6个月，包括记录严重程度评分、血液检查和DLQI。记录任何报告的不良事件。
所有16例患者均完成了6个月的试验。我们的患者之前接受过环孢素治疗（n = 10）、甲氨蝶呤治疗（n = 3）或两者联合治疗（n = 3）。平均EASI评分从基线时的23.38±9.56改善至6个月结束时的8.50±7.57。平均SCORAD评分从基线时的41.25±8.69改善至6个月结束时的14.93±7.82。生活质量也有所改善，因为平均DLQI从基线时的15.18±2.73改善至研究期结束时的5.31±4.11。未观察到严重不良反应，但3例患者出现血脂异常，2例患者出血时间改变。
托法替布是治疗难治性中度至重度成人AD的一种安全有效的治疗选择。
