Tofacitinib in the treatment of recalcitrant cases of psoriasis vulgaris

Abstract

Treatment of recalcitrant cases of psoriasis vulgaris can pose a major challenge to dermatologists. Despite the availability of various drugs and treatment modalities, these cases often either show unsatisfactory response to these treatments or may have to be discontinued due to development of adverse effects or may be contraindicated due to underlying morbidities. After exhausting the conventional modalities such as methotrexate, cyclosporine, acitretin, apremilast, and phototherapy, the next line of management involves usage of biologicals. Biologicals, although efficacious in most cases, come with their own set of drawbacks including cost, availability, and risk of development of anti-drug antibodies, rendering them ineffective. Furthermore, some patients have found to relapse within a few months of stopping them. We present a case series of five patients of refractory psoriasis vulgaris who had exhausted all conventional modalities (including biologicals in three of the patients) who were successfully treated with tofacitinib, a small molecule inhibiting Janus kinase 1/3 enzyme. Our patients have reported no side effects with tofacitinib till date and are continuing to maintain the results. From this series, we conclude that tofacitinib may be an effective therapy for the management of recalcitrant psoriasis.