The following is a summary of “A Retrospective Analysis of Outcome in Melanoma Differentiation–Associated Gene 5–Related Interstitial Lung Disease Treated with Tofacitinib or Tacrolimus” December 2022 issue of The Journal of Rheumatology by Fan, et al.
Tofacitinib (TOF) has been shown to be effective in the early diagnosis of interstitial lung disease (ILD) linked with melanoma differentiation-associated gene 5 (MDA5). However, it is still unclear if being exposed to TOF is linked to a lower mortality rate after 1 year. The study comprised people who were diagnosed with MDA5-ILD and treated with tacrolimus (TAC) or tocilizumab (TOF).
All-cause mortality was compared between the 2 treatment groups, and risk factors for dying within a year were investigated using a Cox proportional hazards model that accounted for age, sex, smoking history, anti-MDA5 antibody titers, and the use of additional steroid-sparing medications. There were a total of 35 patients who had TAC and 26 who received TOF during the study period. Mortality rates in the TOF group were considerably lower than those in the TAC group both after 6 months (38.5% vs 62.9%; P= 0.03) .and after 1 year (44.0% vs. 65.7%; P=0.03). Between the TOF and TAC groups, 13 patients were identified with RP-ILD. Patients diagnosed with RP-ILD accounted for the vast majority of fatalities. Patients with RP-ILD who were assigned to the TOF group had significantly reduced 6-month (76.9% vs 95.5%; P=0.02) and .1-year (84.6% vs 100.0%; P= 0.02) mortality rates than those assigned to the TAC group.
An adjusted model found a protective association between TOF exposure and 1-year mortality (hazard ratio 0.44, 95% CI 0.20-0.96; P=0.04). The rates of adverse events were similar in the TOF and TAC groups (73.1% vs. 74.3%; P>0.99), as were the rates of drug discontinuation (23.1% vs. 14.3%; P=0.50). The results of our observational study suggested that TOF use could impact better outcomes for MDA5-ILD. However, researchers need more long-term clinical trials of TOF to determine its safety and efficacy.