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

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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.

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