Survival benefit of tofacitinib in interstitial lung disease associated with anti-MDA5-positive dermatomyositis: a need for further validation

The study by Wu et al. [1] offers valuable insights into the effectiveness and safety of tofacitinib (TOF) compared to calcineurin inhibitor (CNI) in treating interstitial lung disease (ILD) associated with anti-melanoma differentiation-associated gene 5-positive dermatomyositis (MDA5⁺DM). While their findings suggest a survival benefit for TOF, some methodological concerns must be addressed. A key limitation is the omission of critical prognostic variables from the inverse probability of treatment weighting (IPTW) model, including anti-Ro52 antibodies, KL-6 biomarker levels, and high-resolution computed tomography-based disease severity assessments. Anti-Ro52 positivity is linked to more severe ILD, and KL-6 is a well-established ILD marker. Their absence raises concerns about residual confounding, potentially affecting the observed treatment effects.