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Tofacitinib for the Treatment of Pyoderma Gangrenosum

https://doi.org/10.1016/j.cgh.2018.10.047Get rights and content

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Methods

Patients were treated at the University of North Carolina–Chapel Hill between 2017 and 2018. Immunohistochemical (IHC) staining for phosphorylated Janus kinase (JAK)-1, JAK-2, JAK-3, signal transducer and activator of transcription (STAT)1, and STAT3 was performed on skin biopsy specimens from patients with known PG. Tissue samples were retrieved from a local tissue repository of the Department of Dermatology at the University Hospital Zurich. Antibodies for IHC staining were purchased from

Results

The first patient was a 49-year-old woman with CD status post colectomy with ileostomy and new-onset, lower-extremity PG that was refractory to therapy with golimumab, cyclosporine, and ustekinumab. Because of concomitant arthritis with joint effusions, tofacitinib 5 mg twice daily was initiated. Two weeks after starting tofacitinib, PG lesions improved and joint effusions subsided. By 12 weeks, all PG lesions had completely healed.

The second patient was a 24-year-old man with end-ileostomy

Discussion

We report successful treatment of PG with tofacitinib in IBD patients. Tofacitinib is an oral JAK-1 and JAK-3 inhibitor that has been approved for the treatment of rheumatoid arthritis and ulcerative colitis and currently is being evaluated for plaque psoriasis and inflammatory arthritis.3, 4, 5, 6 JAK-STAT signaling is initiated when a cytokine attaches to its target cell surface receptor, which leads to phosphorylation of the receptor-associated JAK molecules followed by phosphorylation of

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    Citation Excerpt :

    Although infliximab alone showed poor efficacy, infliximab combined with 10 mg TOF twice daily for 3 weeks led to complete remission of lesions, including of the skin and intestine. In another study, 3 patients with CD and PG were treated with TOF at doses of 5–10 mg/12 h for 12 weeks, and symptoms of PG improved in all 3 [11]. Orfaly et al. originally reported symptom improvement in 2 patients with PG treated with TOF; one had UC, and the other had unclassified IBD [26].

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Conflicts of interest This author discloses the following: Hans H. Herfarth has received consulting fees from Alivio, AMAG, Boehringer-Ingelheim, Merck, and Seres, fees for serving on the data safety monitoring boards of Celltrion, Finch, Gilead, Lycera, and Pfizer, and research support from Artizan and Pfizer. The remaining authors disclose no conflicts.

Funding This research was supported by a grant from the Crohn's and Colitis Foundation (568735; B.K.).

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