The Efficacy and Safety of Tofacitinib in Anti-melanoma Differentiation-associated Gene 5 Antibody Positive Dermatomyositis Associated Interstitial Lung Disease: a Systematic Review and Meta-analysis

Overview

Journal Ther Adv Respir Dis

Publisher Sage Publications

Specialties Pharmacology
Pulmonary Medicine

Date 2024 Oct 31

PMID 39480695

Authors

Yanhong Wang

Ruyi Zou

Jie Wei

Cheng Tang

Junjie Wang

Minjie Lin

Affiliations

Soon will be listed here.

Abstract

Background: The presence of anti-melanoma differentiation-associated gene 5 (MDA5) antibodies in dermatomyositis (DM) is associated with an increased risk of developing rapidly progressive interstitial lung disease (RP-ILD) and a poor prognosis.

Objectives: We aimed to explore whether tofacitinib could improve the prognosis of Anti-MDA5 antibody positive DM-interstitial lung disease (ILD).

Design: Systematic review and meta-analysis.

Data Sources And Methods: Studies were included if they compared mortality rate and infection events in patients with anti-MDA5 antibody positive DM-associated ILD who were treated with or without tofacitinib.

Results: The systematic review and meta-analysis included a total of 148 patients from four cohort studies. Fifty-eight patients with anti-MDA5 antibody positive DM-ILD who received combined treatment-containing tofacitinib were enrolled in the experimental group. Additionally, 90 DM-ILD patients who did not receive tofacitinib-based therapy were included in the control group. The pooled risk ratio (RR) for all-cause mortality was 0.61 (95% CI, 0.41-0.91, = 0.02) with = 0 indicating no heterogeneity among the included studies. For virus infection risk, the pooled RR was 1.92 (95% CI, 0.90-4.10, = 0.09), while bacterial and fungal infection-associated RRs were found to be 1.29 (95% CI, 0.65-2.55, = 0.47) and 1.15 (95% CI, 0.46-2.89, = 0.77), respectively. There was no statistically significant difference in infection risk between the two groups, and no heterogeneity was observed.

Conclusion: Our findings suggest that tofacitinib may reduce the risk of all-cause mortality in patients with anti-MDA5 antibody-positive DM-ILD without an increased risk of additional infections.

Trial Registration: PROSPERO: CRD42023445427; https://www.crd.york.ac.uk/prospero/.

References

Wang Y, Luo J, Lv X, Li Y, An Q, Mo L . Tofacitinib for new-onset adult patients with anti-melanoma differentiation-associated 5 gene antibody positive dermatomyositis. Clin Rheumatol. 2023; 42(7):1847-1853. DOI: 10.1007/s10067-023-06567-y. View

Greenberg S . Sustained autoimmune mechanisms in dermatomyositis. J Pathol. 2014; 233(3):215-6. DOI: 10.1002/path.4355. View

Stang A . Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010; 25(9):603-5. DOI: 10.1007/s10654-010-9491-z. View

Wang K, Zhao J, Chen Z, Li T, Tan X, Zheng Y . CD4+CXCR4+ T cells as a novel prognostic biomarker in patients with idiopathic inflammatory myopathy-associated interstitial lung disease. Rheumatology (Oxford). 2018; 58(3):511-521. DOI: 10.1093/rheumatology/key341. View

McPherson M, Economidou S, Liampas A, Zis P, Parperis K . Management of MDA-5 antibody positive clinically amyopathic dermatomyositis associated interstitial lung disease: A systematic review. Semin Arthritis Rheum. 2022; 53:151959. DOI: 10.1016/j.semarthrit.2022.151959. View

Gono T, Kawaguchi Y, Kuwana M, Sugiura T, Furuya T, Takagi K . Brief report: Association of HLA-DRB1*0101/*0405 with susceptibility to anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis in the Japanese population. Arthritis Rheum. 2012; 64(11):3736-40. DOI: 10.1002/art.34657. View

Paik J, Casciola-Rosen L, Shin J, Albayda J, Tiniakou E, Leung D . Study of Tofacitinib in Refractory Dermatomyositis: An Open-Label Pilot Study of Ten Patients. Arthritis Rheumatol. 2020; 73(5):858-865. PMC: 8084900. DOI: 10.1002/art.41602. View

Lundberg I, Tjarnlund A, Bottai M, Werth V, Pilkington C, de Visser M . 2017 European League Against Rheumatism/American College of Rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups. Ann Rheum Dis. 2017; 76(12):1955-1964. PMC: 5736307. DOI: 10.1136/annrheumdis-2017-211468. View

Chen Z, Wang Y, Kuwana M, Xu X, Hu W, Feng X . HLA-DRB1 Alleles as Genetic Risk Factors for the Development of Anti-MDA5 Antibodies in Patients with Dermatomyositis. J Rheumatol. 2017; 44(9):1389-1393. DOI: 10.3899/jrheum.170165. View

10.

Chen Z, Wang X, Ye S . Tofacitinib in Amyopathic Dermatomyositis-Associated Interstitial Lung Disease. N Engl J Med. 2019; 381(3):291-293. DOI: 10.1056/NEJMc1900045. View

11.

Mease P, Hall S, FitzGerald O, van der Heijde D, Merola J, Avila-Zapata F . Tofacitinib or Adalimumab versus Placebo for Psoriatic Arthritis. N Engl J Med. 2017; 377(16):1537-1550. DOI: 10.1056/NEJMoa1615975. View

12.

Kurasawa K, Arai S, Namiki Y, Tanaka A, Takamura Y, Owada T . Tofacitinib for refractory interstitial lung diseases in anti-melanoma differentiation-associated 5 gene antibody-positive dermatomyositis. Rheumatology (Oxford). 2018; 57(12):2114-2119. DOI: 10.1093/rheumatology/key188. View

13.

Dhillon S . Tofacitinib: A Review in Rheumatoid Arthritis. Drugs. 2017; 77(18):1987-2001. DOI: 10.1007/s40265-017-0835-9. View

14.

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . Updating guidance for reporting systematic reviews: development of the PRISMA 2020 statement. J Clin Epidemiol. 2021; 134:103-112. DOI: 10.1016/j.jclinepi.2021.02.003. View

15.

Jiang J, Ghoreschi K, Deflorian F, Chen Z, Perreira M, Pesu M . Examining the chirality, conformation and selective kinase inhibition of 3-((3R,4R)-4-methyl-3-(methyl(7H-pyrrolo[2,3-d]pyrimidin-4-yl)amino)piperidin-1-yl)-3-oxopropanenitrile (CP-690,550). J Med Chem. 2008; 51(24):8012-8. PMC: 2660606. DOI: 10.1021/jm801142b. View

16.

Lin J, Zhang Y, Peng Q, Yang H, Shi J, Gu M . Genetic association of HLA-DRB1 multiple polymorphisms with dermatomyositis in Chinese population. HLA. 2017; 90(6):354-359. DOI: 10.1111/tan.13171. View

17.

Cohen S, Tanaka Y, Mariette X, Curtis J, Lee E, Nash P . Long-term safety of tofacitinib for the treatment of rheumatoid arthritis up to 8.5 years: integrated analysis of data from the global clinical trials. Ann Rheum Dis. 2017; 76(7):1253-1262. PMC: 5530353. DOI: 10.1136/annrheumdis-2016-210457. View

18.

Wang C, Wong T, Hsu S . Extended-release tofacitinib for refractory Behçet disease: A case report. Medicine (Baltimore). 2022; 101(15):e29189. PMC: 9276400. DOI: 10.1097/MD.0000000000029189. View

19.

Fan L, Lyu W, Liu H, Jiang H, Chen L, Liu Y . A Retrospective Analysis of Outcome in Melanoma Differentiation-Associated Gene 5-Related Interstitial Lung Disease Treated with Tofacitinib or Tacrolimus. J Rheumatol. 2022; 49(12):1356-1364. DOI: 10.3899/jrheum.220367. View

20.

Shirai T, Machiyama T, Sato H, Ishii T, Fujii H . Intensive induction therapy combining tofacitinib, rituximab and plasma exchange in severe anti-melanoma differentiation-associatedprotein-5 antibody-positive dermatomyositis. Clin Exp Rheumatol. 2023; 41(2):291-300. DOI: 10.55563/clinexprheumatol/8kulbf. View