Tofacitinib induces remission in cutaneous sarcoidosis, granuloma annulare

A small study has recently shown the effectiveness of Janus kinase (JAK) inhibitor tofacitinib in the treatment of cutaneous sarcoidosis and granuloma annulare (GA).

“Sarcoidosis and GA are cutaneous granulomatous disorders that can be difficult to treat,” according to the researchers, noting evidence of an underlying JAK-signal transducer and activator of transcription (STAT) pathway activation in sarcoidosis.

Use of tofacitinib led to a mean improvement in the baseline Cutaneous Sarcoidosis Activity and Morphology Instrument and Granuloma Annulare Scoring Index score of 96 percent (standard deviation, 2 percent).

All patients (100 percent) who had skin biopsies while receiving tofacitinib showed histologic resolution of the disease. Constitutive STAT1 and STAT3 activation was also seen in both sarcoidosis and GA, albeit in different patterns. Such differences in JAK-STAT signaling between sarcoidosis and GA could be potentially explained by the signal regulatory protein α.

This prospective study assessed the effectiveness of JAK inhibitor tofacitinib in four consecutive patients with recalcitrant cutaneous sarcoidosis (n=3) and generalized GA (n=1). Patterns of JAK-STAT pathway activation were characterized by performing immunohistochemical analysis of skin biopsy specimens from other patients with sarcoidosis (n=21) and GA (n=17).

The study was limited by its small number of participants, according to the researchers, adding that larger studies are ongoing to improve understanding of the therapeutic effects of tofacitinib.