Management of refractory cutaneous dermatomyositis: potential role of Janus kinase inhibition with tofacitinib

OBJECTIVES: Some patients with cutaneous DM demonstrate incomplete responses to conventional therapy while some, including those with extra-cutaneous manifestations, experience disease recurrences. Janus kinase/signal transducers and activators of transcription pathway inhibition has been reported to mitigate IFN signalling, which is thought to contribute to disease pathogenesis in DM. Four cases of refractory DM responsive to tofacitinib have been reported in the literature. Our case series investigated the use of tofacitinib in refractory cutaneous DM. METHODS: Our case series includes four subjects with refractory DM who received tofaticinib after failure of several immunosuppressive and immunomodulatory agents. RESULTS: All four subjects responded well to tofacitinib with significant improvement in cutaneous and extra-cutaneous manifestations. CONCLUSION: Tofacitinib can improve cutaneous and inflammatory articular manifestations in refractory DM.