Combined therapy of tofacitinib plus iguratimod improves rheumatoid arthritis-usual interstitial pneumonia

According to a recent study published in Frontiers in Immunology, the combination of tofacitinib and iguratimod is superior to conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs)  with a greater response rate in rheumatoid arthritis (RA)-usual interstitial pneumonia (UIP). The combination therapy has the potential to simultaneously reduce both RA and RA-UIP. 

In a prospective observational cohort setting, Xie and colleagues conducted a single-center study comprising 78 patients with RA-UIP. Treatment for the patients included tofacitinib plus iguratimod, iguratimod plus csDMARDs, and csDMARDs alone. Patients were observed for at least six months following therapy. Forced vital capacity (FVC%) (84.7 ± 14.7 vs 90.7 ± 15.4) and high-resolution chest CT scan (HRCT) fibrosis score (7.3 ± 3.4 vs 7.0 ± 5.6) both improved significantly compared to the csDMARD group after 6 months of tofacitinib plus iguratimod therapy (P = 0.031, P = 0.015). The tofacitinib plus iguratimod-treated patients had considerably greater regression and less deterioration than the csDMARD-treated patients. They also had a significantly higher regression plus stability with overall response rates of 66.7% versus 35.7% (P = 0.027). 

A review study by Wang et al. comprising three case studies of patients with RA-UIP  treated with the combined tofacitinib plus iguratimod suggested the effectiveness of tofacitinib plus iguratimod in pulmonary fibrosis. The Disease Activity Score-28 for rheumatoid arthritis with CRP (DAS28CRP) was below 2.6 in all three case studies, while the pulmonary function test and HRCT results were constant. In the three case studies, chest HRCT lesions not only improved but also remained steady or unexpanded, and considerably reversed, in as minimum as three months. 

The study results indicate the potential of combining tofacitinib and iguratimod as a dual treatment strategy for addressing both RA and RA-UIP simultaneously. This innovative approach holds promise, especially in cases where the efficacy or tolerability of DMARDs is limited, considering that conventional DMARDs alone may prove inadequate for treating RA-UIP. To further substantiate these findings, it will be imperative to conduct future prospective research on a larger cohort.  

References 

  1. Weilin Xie, Shuhua Wang, Yao Li, Yanchun Tang, Yue Zhang, Qingyan Liu. A prospective observational cohort study of the efficacy of tofacitinib plus iguratimod on rheumatoid arthritis-usual interstitial pneumonia. Front. Immunol 2023 Volume 14 
  2. Shuhua Wang, Yao Li, Yanchun Tang, Weilin Xie. Tofacitinib plus iguratimod for improving rheumatoid arthritis-related usual interstitial pneumonia: a three-case report and literature review. Authorea. 2022 August 30. 

 

 

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