Efficacy of Tofacitinib in Takayasu Arteritis Refractory to Biologic DMARDs—A Multicentre Study in Indian Patients

Background

The management of patients with Takayasu arteritis (TAK), especially those who are refractory to biologic disease-modifying anti-rheumatic drugs (DMARDs), is challenging.

Objective

We determined the efficacy of tofacitinib in patients with TAK who could not achieve or maintain stable disease despite biologic DMARDs (bDMARD-NR).

Methods

Details of consecutive patients with TAK treated with originator/generic tofacitinib at 5 centres in India were recorded retrospectively from the medical records. The activity of the disease was assessed using multiple domains including Indian Takayasu arteritis score (ITAS), C-reactive protein (CRP) and imaging. Active disease was defined by either (i) ITAS-A(CRP) ≥ 3 wherein both ITAS and CRP each contributed at least 1 point to the final score; or (ii) clinical ITAS score > 1 in the presence of imaging activity even without raised CRP. The parameters between patients with good response and no response to treatment were compared.

Results

Altogether, 33 patients (30 females) with a mean age of 28.9 ± 7.6 years and a disease duration of 39.0 (15.8–72.0) months who received tofacitinib were included. Sixteen patients (54.5%) who failed anti-TNF agents [n = 14, (42.4%)] or tocilizumab [n = 14, (42.4%)] were classified as bDMARD-NR. During a follow-up of 15.0 (6.5–20.0) months, 23 (69.7%) satisfied the above composite criteria for inactive disease using clinical, laboratory, and imaging parameters. Among bDMARD-NR, 14 (77.8%) achieved inactive disease. Four patients discontinued tofacitinib due to adverse drug events. No predictors of response were identified.

Conclusion

Tofacitinib may be an effective option in a subset of patients who fail to attain stable disease state despite use of csDMARDs and bDMARDs.