Inhibition of type 1 immunity with tofacitinib is associated with marked improvement in longstanding sarcoidosis
William Damsky, Alice Wang, Daniel J Kim, Bryan D Young, Katelyn Singh, Michael J Murphy, Joseph Daccache, Abigale Clark, Ruveyda Ayasun, Changwan Ryu, Meaghan K McGeary, Ian D Odell, Ramesh Fazzone-Chettiar, Darko Pucar, Robert Homer, Mridu Gulati, Edward J Miller, Marcus Bosenberg, Richard A Flavell, Brett King, William Damsky, Alice Wang, Daniel J Kim, Bryan D Young, Katelyn Singh, Michael J Murphy, Joseph Daccache, Abigale Clark, Ruveyda Ayasun, Changwan Ryu, Meaghan K McGeary, Ian D Odell, Ramesh Fazzone-Chettiar, Darko Pucar, Robert Homer, Mridu Gulati, Edward J Miller, Marcus Bosenberg, Richard A Flavell, Brett King
Abstract
Sarcoidosis is an idiopathic inflammatory disorder that is commonly treated with glucocorticoids. An imprecise understanding of the immunologic changes underlying sarcoidosis has limited therapeutic progress. Here in this open-label trial (NCT03910543), 10 patients with cutaneous sarcoidosis are treated with tofacitinib, a Janus kinase inhibitor. The primary outcome is the change in the cutaneous sarcoidosis activity and morphology instrument (CSAMI) activity score after 6 months of treatment. Secondary outcomes included change in internal organ involvement, molecular parameters, and safety. All patients experience improvement in their skin with 6 patients showing a complete response. Improvement in internal organ involvement is also observed. CD4+ T cell-derived IFN-γ is identified as a central cytokine mediator of macrophage activation in sarcoidosis. Additional type 1 cytokines produced by distinct cell types, including IL-6, IL-12, IL-15 and GM-CSF, also associate with pathogenesis. Suppression of the activity of these cytokines, especially IFN-γ, correlates with clinical improvement. Our results thus show that tofacitinib treatment is associated with improved sarcoidosis symptoms, and predominantly acts by inhibiting type 1 immunity.
Conflict of interest statement
W.D. has research funding from Pfizer and Advanced Cell Diagnostics/Bio-techne, serves as a consultant for Eli Lilly, Pfizer, Incyte, and Twi Biotechnology, and receives licensing fees from EMD/Millipore/Sigma. B.D.Y receives research funding from Pfizer. E.J.M. receives research funding from Alnylam, Pfizer, and Eidos and serves as a consultant for Alnylam, Pfizer, and Eidos. D.P. receives consulting fees from Telix Pharmaceuticals and Cohere Health. M.B. is a consultant for Eli Lilly and receives licensing fees from EMD/Millipore//Sigma. R.A.F. is a consultant for Glaxo Smith Kline and Zai labs. B.K. is a consultant to and/or has served on advisory boards for Aclaris Therapeutics, Arena Pharmaceuticals, Bristol-Meyers Squibb, Concert Pharmaceuticals Inc, Dermavant Sciences, Eli Lilly and Company, Pfizer, and VielaBio; he is on speaker’s bureau for Pfizer, Regeneron and Sanofi Genzyme. A.W., D.J.K., K.S., M.J.M., J.D., A.C., R.A., C.R., M.K.M., I.D.O., R.F.C., R.H. and M.G. have no disclosures.
© 2022. The Author(s).
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