Tofacitinib may be an effective treatment for chronic pruritus in patients with concomitant rheumatoid arthritis (RA), according to a letter published in JAMA Dermatology.

Investigators presented data on tofacitinib efficacy observed in 5 patients (4 women; mean age, 65.0±12.4 years) with chronic pruritus of unknown origin (CPUO). Patients noted severity of their itches in the last 24 hours, using the numerical rating scale (NRS). Initial NRS scores ranged from 9 to 10 (range, 9.5-10), with mean symptom duration of 13.2±6.8 months. All patients had concomitant RA and no evidence of a dermatologic disorder.

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After receiving CPUO diagnoses, all patients were prescribed 5 mg oral tofacitinib twice daily for a mean duration of 7.8±4.6 months. Patients had also received other off-label anti-itch therapies before tofacitinib initiation, including antihistamines, gabapentin, prednisone, moisturizers, and topical steroids. Chronic pruritus of unknown origin did not improve in all patients with RA; however, there was a significant improvement in the NRS itch score.

According to these data, investigators endorsed further study of tofacitinib and other Janus kinase inhibitors for the treatment of chronic itch. Given the small study cohort, no explicit conclusions may be drawn. Instead, randomized clinical trials of tofacitinib for the treatment of CPUO are necessary to confirm the anti-itch properties of Janus kinase inhibitors.

Disclosure: Several authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Wang F, Morris C, Bodet ND, Kim BS. Treatment of refractory chronic pruritus of unknown origin with tofacitinib in patients with rheumatoid arthritis [published online September 18, 2019]. JAMA Dermatol. doi:10.1001/jamadermatol.2019.2804