Retrospective comparative study of the efficacy of JAK inhibitor (tofacitinib) in the treatment of systemic sclerosis-associated interstitial lung disease

The oral Janus kinases inhibitor (JAKi) has improved the management of skin manifestations in systemic sclerosis (SSc), and our study aimed to explore the efficacy of non-selective JAKi tofacitinib in ameliorating interstitial lung disease (ILD) in the patients with SSc. The hospitalization data of the SSc-ILD patients from April 2019 to April 2021 were collected, and the changes of pulmonary function and the radiological findings in pulmonary high-resolution CT (HRCT) from the 9 patients who received tofacitinib for at least 6 months and a matched group of 35 SSc-ILD patients treated with conventional immunosuppressants or glucocorticoids, were compared and analyzed. There were no significant differences in demographic data and clinical characteristics between the tofacitinib-treated group (tofa-group) and the matched group. However, in the tofa-group, the changes in serum lactate dehydrogenase (LDH) concentration and serum interleukin-6 levels were significantly lower than those in the matched group. Moreover, the tofa-group showed amelioration in decreased diffusing capacity of the lung for carbon monoxide (DLCO) (62.05 +/- 9.47 vs. 66.61 +/- 12.39, p = 0.046), reductions in ground-glass attenuation involvement (1.00 +/- 0.86 vs. 0.33 +/- 0.50, p = 0.024) and irregular pleural thickening (1.33 +/- 0.50 vs. 0.67 +/- 0.51, p = 0.004) in pulmonary HRCTs, alleviated modified Rodnan skin score (mRSS) of skin sclerosis (9.22 +/- 3.81 vs. 7.11 +/- 3.92, p = 0.048), and reduced HRCT scores of pulmonary fibrosis (15.00 +/- 3.87 vs. 12.66 +/- 4.92, p = 0.009). Logistic regression analysis showed that the involvement of ground-glass attenuation (OR 11.43) and the add-on therapy of tofacitinib (OR 9.98) were the relevant factors in the amelioration of HRCT. Our results indicate that the use of JAKi (tofacitinib) may be relevant to significant improvement of the sclerosis and early radiological abnormalities in SSc-ILD patients. Further studies are needed to confirm these findings and to explore its efficacy more precisely.

Automated summary

Non-selective JAKi tofacitinib has been shown to improve interstitial lung disease (ILD) in patients with systemic sclerosis (SSc), reducing serum lactate dehydrogenase (LDH) concentration and interleukin-6 levels, improving lung function, and alleviating pulmonary HRCT findings including ground-glass attenuation and irregular pleural thickening. Tofacitinib also helps in ameliorating skin sclerosis and reducing pulmonary fibrosis in SSc-ILD patients. Further studies are needed to confirm these findings and explore the efficacy in more detail.