Background: The presence of anti-melanoma differentiation-associated gene 5 (MDA5) antibodies in dermatomyositis (DM) is associated with an increased risk of developing rapidly progressive interstitial lung disease (RP-ILD) and a poor prognosis.
Objectives: We aimed to explore whether tofacitinib could improve the prognosis of Anti-MDA5 antibody positive DM-interstitial lung disease (ILD).
Design: Systematic review and meta-analysis.
Data sources and methods: Studies were included if they compared mortality rate and infection events in patients with anti-MDA5 antibody positive DM-associated ILD who were treated with or without tofacitinib.
Results: The systematic review and meta-analysis included a total of 148 patients from four cohort studies. Fifty-eight patients with anti-MDA5 antibody positive DM-ILD who received combined treatment-containing tofacitinib were enrolled in the experimental group. Additionally, 90 DM-ILD patients who did not receive tofacitinib-based therapy were included in the control group. The pooled risk ratio (RR) for all-cause mortality was 0.61 (95% CI, 0.41-0.91, p = 0.02) with I2 = 0 indicating no heterogeneity among the included studies. For virus infection risk, the pooled RR was 1.92 (95% CI, 0.90-4.10, p = 0.09), while bacterial and fungal infection-associated RRs were found to be 1.29 (95% CI, 0.65-2.55, p = 0.47) and 1.15 (95% CI, 0.46-2.89, p = 0.77), respectively. There was no statistically significant difference in infection risk between the two groups, and no heterogeneity was observed.
Conclusion: Our findings suggest that tofacitinib may reduce the risk of all-cause mortality in patients with anti-MDA5 antibody-positive DM-ILD without an increased risk of additional infections.
Trial registration: PROSPERO: CRD42023445427; https://www.crd.york.ac.uk/prospero/.
Keywords: anti-melanoma differentiation-associated gene 5; interstitial lung disease; tofacitinib dermatomyositis.
Tofacitinib is being utilized in the treatment of a type of dermatomyositis-associated rapidly progressive interstitial lung diseaseWhy was the study conducted? Currently, despite the utilization of conventional treatments for anti-melanoma differentiation-associated gene 5 (MDA5) antibody-positive dermatomyositis (DM)-associated interstitial lung disease (ILD), the 6-month mortality rate still remains alarmingly high. Therefore, it is imperative for us to explore novel therapeutic approaches aiming at controlling the rapid progression of this disease.What did the researchers do? The research team explored mortality rates and infection events in patients with anti-MDA5 antibody-positive DM–ILD who were treated with or without tofacitinib.What did the researchers find? Our study revealed that tofacitinib resulted in a significant reduction in the risk of all-cause mortality. When considering infection risk, there was no statistically significant difference observed in terms of viral, bacterial, or fungal infections compared with the control group.What do the findings mean? Our study suggests that tofacitinib demonstrates both efficacy and safety in treating anti-MDA5 positive DM-ILD.