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Case report
First use of tofacitinib to treat an immune checkpoint inhibitor-induced arthritis
  1. Kieran Murray1,
  2. Achilleas Floudas1,2,
  3. Ciara Murray3,
  4. Aurelie Fabre3,
  5. John Crown3,
  6. Ursula Fearon1,2 and
  7. Douglas Veale1,3
  1. 1EULAR Centre for Arthritis and Rheumatic Disease, St. Vincent's University Hospital, Dublin, Ireland
  2. 2Molecular Rheumatology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
  3. 3Pathology, Oncology and Medicine, University College Dublin, Dublin, Ireland
  1. Correspondence to Professor Douglas Veale; douglas.veale{at}ucd.ie

Abstract

Immune checkpoint inhibitors have revolutionised cancer treatment; however, immune-related adverse events do occur, with up to 7% developing inflammatory arthritis. Common rheumatoid arthritis therapies such as methotrexate, prednisolone and biologics have been used to treat this arthritis in small, uncontrolled case series with varying success. In this case of personalised medicine, we report the first use of tofacitinib, a small molecular inhibitor of the Janus kinase-signal transducer and activator of transcription pathway, to treat checkpoint inhibitor-related inflammatory arthritis. This resulted in a rapid clinical response and complete, sustained remission of the arthritis with associated marked reduction in synovial molecular and cellular immune response.

  • malignant disease and immunosuppression
  • drugs: musculoskeletal and joint diseases

https://doi.org/10.1136/bcr-2020-238851

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    Footnotes

    • Twitter @dougveale

    • Contributors KM, AF (Aurelie Fabre, Dept of Pathology, UCD), JC (John Crown, Dept. of Oncology, UCD), DV were involved in the care of the patient. AF and UF performed and analysed the flow cytometry. CM (Ciara Murray, Dept of Pathology, UCD) and AF performed the immunohistochemical analysis. KM, AF, CM, AF, JC, UF and DV were involved in drafting the manuscript. The authors were solely responsible for final review and approval of the report. The corresponding author had final responsibility for the decision to submit for publication.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.