PA06 Efficacy and safety of oral tofacitinib in children with moderate-to-severe atopic dermatitis: a retrospective analysis

Abstract Atopic dermatitis (AD) is a common childhood dermatosis, with T helper (Th)2 cells being a major contributor. Tofacitinib, a Janus kinase 1 and 3 receptor inhibitor, inhibits Th2- and Th17-associated cytokines. The role of tofacitinib in AD is being explored in adults but limited data are available in children. Our study explores the safety and efficacy of oral tofacitinib in moderate-to-severe AD in children. This retrospective study included children aged < 12 years with moderate-to-severe AD who were on tofacitinib for 6 months. In total, 15 children on oral tofacitinib 2.5 mg once or twice daily were included in the study. These comprised nine males (60%) and six girls (40%) with a mean age of 7.8 years (SD 3.1). The baseline mean Scoring Atopic Dermatitis (SCORAD) was 49.1 (SD 9.4). Nine children (60%) were previously treated with oral steroids and three with ciclosporin. The SCORAD decreased significantly to 13.9 (SD 7.9) after 6 months of treatment (Mann–Whitney test, P < 0.01). A significant decrease in SCORAD was observed within 2 weeks of starting treatment (mean 37.5, SD 7.5; Mann–Whitney test, P < 0.01). Four children discontinued treatment: one was lost to follow-up and three had disease progression and required continuous steroid intake. Only one child required a single episode of short-course oral steroids. The mean percentage decrease in SCORAD was 57.2% (SD 34.9%) and ≥ 75% improvement in SCORAD was achieved in three patients (20%). The most common side-effect was skin infections (33%) (recurrent furunculosis in four children and eczema herpeticum in one), followed by fever (27%) and nasopharyngitis (20%). A mild transient decrease in total leucocyte count was encountered in a child. In conclusion, oral tofacitinib is considerably safe and efficacious in treating moderate-to-­severe AD in children and can be useful in refractory cases.