DRESS: Tofacitinib Shows Glucocorticoid-Sparing Potential
Key Takeaways
- Results from a retrospective real-world study of 61 patients with drug reaction with eosinophilia and systemic symptoms (DRESS) showed adjunctive tofacitinib was associated with lower cumulative glucocorticoid exposure and shorter treatment duration.
- Patients receiving tofacitinib plus systemic glucocorticoids reached near-complete rash resolution sooner than those receiving glucocorticoids alone.
- Investigators called for prospective randomized controlled trials to validate the findings.
Adding tofacitinib to systemic glucocorticoid therapy was associated with reduced glucocorticoid exposure and faster clinical improvement among patients with drug reaction with eosinophilia and systemic symptoms (DRESS), according to a study published online in the Journal of the American Academy of Dermatology.
Adjunctive Tofacitinib Reduced Glucocorticoid Exposure in DRESS
Investigators retrospectively evaluated patients with DRESS treated between January 2018 and June 2025, comparing systemic glucocorticoids alone with glucocorticoids plus tofacitinib. The primary outcome was cumulative glucocorticoid exposure; secondary outcomes included clinical improvement and safety. Multivariable regression and sensitivity analyses were used to address potential confounding.
The analysis included 61 patients (60.7% female) and 25 (41.0%) had severe DRESS. Adjunctive tofacitinib was associated with a shorter median time to near-complete rash resolution compared with glucocorticoids alone (10.0 vs 13.5 days; P = 0.032).
Patients receiving tofacitinib also had shorter glucocorticoid treatment duration (58.0 vs 88.0 days; P < 0.001) and lower cumulative glucocorticoid exposure (1452.0 vs 2145.0 mg; P = 0.019). After adjustment for potential confounders, tofacitinib remained associated with a 24.9% reduction in glucocorticoid treatment duration (P = 0.029). Six-month mortality was 0% with adjunctive tofacitinib versus 10.7% with glucocorticoids alone, although the difference was not statistically significant (P = 0.091).
The retrospective design and small sample limit causal conclusions.
“Adjunctive tofacitinib was associated with significant glucocorticoid-sparing effects in DRESS,” the authors wrote. “Prospective randomized controlled trials are needed for validation.”