• Kazuhiro Kurasawa, Satoko Arai, Yumeko Namiki, Ayae Tanaka, Yuta Takamura, Takayoshi Owada, Masafumi Arima, and Reika Maezawa.
• Department of Rheumatology, Dokkyo Medical University, Tochigi, Japan.
• Rheumatology (Oxford). 2018 Dec 1; 57 (12): 2114-2119.

ObjectiveWe aimed to determine the outcome of combination therapy with tofacitinib (TOF) in a case series of refractory rapidly progressive interstitial lung disease (ILD) associated with anti-melanoma differentiation-associated 5 gene (MDA5) antibody-positive (Ab+) DM. Patients who had poor prognostic factors and failed to respond to immunosuppressive therapy were selected for TOF treatment.MethodsFive patients with anti-MDA5 Ab+ DM-ILD who failed to respond to triple therapy with high dose glucocorticoids, CSA and CYC were given additional TOF (10 mg/day). To identify the poor prognostic factors, data from 15 consecutive patients (seven survived and eight died) with anti-MDA5 Ab+ DM-ILD before induction of TOF were analysed.ResultsThree poor prognostic factors were identified: serum ferritin level >1000 ng/ml before therapy; ground-glass opacities in all six lung fields before therapy; and worsening of pulmonary infiltrates during therapy. All six patients who had all of the three factors and received triple therapy died before TOF therapy. There were five patients who had all of the three prognostic factors and failed to respond to triple therapy, but were able to receive the combination therapy with TOF; among them, three survived and two died. The survival rate of patients who received TOF was significantly better than that of the historical controls with immunosuppressive therapy before TOF. The patients who received TOF experienced complicated adverse events, particularly viral infection.ConclusionCombination therapy with TOF might have the potential to control refractory anti-MDA5 Ab+ DM-ILD.

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