Tofacitinib Triggers Celiac Disease Remission in a Gluten-Eating Patient

By Anne Harding

July 29, 2020

NEW YORK (Reuters Health) - A patient who started tofacitinib therapy for alopecia areata had complete histologic and serologic remission of his celiac disease (CD), despite being on a gluten-containing diet, according to a new case report.

"This is a very interesting finding, but it's only one patient, one case," Dr. Lucas Wauters of University Hospitals Leuven in Belgium told Reuters Health by phone. He and his colleagues are awaiting the findings of a trial of tofacitinib as salvage therapy for patients with refractory CD type II, now underway at VU Medical Center, to move forward with additional studies.

In the current report, published in the Annals of Internal Medicine, a patient diagnosed with CD at age 1 year and alopecia areata at age 13 stopped his gluten-free diet at age 16 after going into remission. The re-introduction of gluten led to a relapse of severe small intestinal damage, but the patient reported no intestinal or extraintestinal symptoms.

He decided to continue on a gluten-containing diet, and the histologic and serologic abnormalities were still present in 2018. The following year, he began taking 5 mg of tofacitinib twice daily for alopecia. In 2020, follow-up studies showed full histologic and serologic remission of CD.

The patient continued taking tofactinib with regular blood tests to monitor blood count, lipid levels and creatine kinase.

"The efficacy of tofacitinib in alopecia areata may also be related to inhibition of CD8+ T-cell reactions to follicle-associated autoantigens," Dr. Wauters and his team write.

If the findings are confirmed, the researcher noted, the advantages of tofacitinib for patients with refractory CD could outweigh the potential risks. While the patient in the case report was on the maximum therapeutic dose of tofacitinib, he added, lower doses with a better safety profile may also be effective, and could be tested in patients with CD who have unintentional gluten exposure.

"It's interesting to use one drug which would target both diseases," Dr. Wauters added, noting that there are drugs now available that treat both psoriatic arthritis and inflammatory bowel disease.

SOURCE: Annals of Internal Medicine, online July 27, 2020.