Tofacitinib therapy in refractory inflammatory myositis: a retrospective cohort study of 41 patients.

OBJECTIVES: To evaluate the efficacy and safety of tofacitinib in treatment-refractory inflammatory myositis in a real-world clinical setting. METHODS: All patients with refractory inflammatory myositis treated with tofacitinib from a single urban center in Vancouver, British Columbia, Canada, were included from June 2016 to December 2022. The medical records of these patients were retrospectively reviewed. RESULTS: A total 41 patients were included, 23 with classic dermatomyositis (DM), 12 with amyopathic DM (ADM) and 6 with polymyositis (PM) phenotype. The patients failed an average of 4-5 non-steroidal immunosuppressants before initiation of tofacitinib. In the classic DM and ADM group, tofacitinib offered clinically and statistically significant cutaneous improvement. In all myositis patients including the PM phenotype, no meaningful muscle strength response to tofacitinib was observed. 53.7% of the patients discontinued tofacitinib due to lack of benefit or death. Of the 19 patients who remained on tofacitinib at the conclusion of this study, tofacitinib demonstrated clinically and statistically significant improvement in cutaneous disease activity. CONCLUSION: Tofacitinib appears to be highly effective in targeting cutaneous manifestations in classic DM and ADM; however, minimal benefit in muscle strength in the DM or PM phenotype were observed.

Surgical excision combined with fully ablative carbon dioxide laser therapy and triamcinolone injections as a potential treatment for keloids in children.

BACKGROUND/OBJECTIVE: Keloids represent a functional and esthetic burden and can be particularly challenging to treat. Various topical, injectable, and ablative therapies exist but are associated with significant recurrence if used alone. We wanted to evaluate the long-term efficacy of multimodal therapy in pediatric patients treated for keloids at the Sainte-Justine University Hospital Center. METHODS: We conducted a retrospective case study of 21 children with 21 keloids treated between April 2006 and April 2016. The following combination of treatments was studied: surgical excision, carbon dioxide (CO2 ) laser therapy on the surgical site, and triamcinolone acetonide (TAC) intralesional injections during surgery and follow-up. Depending on the site treated, pressure garments and/or topical silicone were also used. RESULTS: Of the 21 patients initially treated, four were lost to follow-up. Of the 17 patients who had adequate follow-up (mean duration 18 months, with periodic reassessments and additional TAC injections if needed), 6 (35%) had some recurrence, with remission in three of them following subsequent treatment and three lost to follow-up. In summary, 14 (82.4%) of the patients with adequate follow-up had complete clearance of the keloid. However, this must be interpreted in light of the fact there was a significant loss of follow-up (33.3%) from the initial cohort. CONCLUSION: Our results are in agreement with other recent studies that demonstrate the need for multimodal therapy with combined methods in order to achieve long-term remission. A randomized controlled trial would be necessary to assess the real benefit of this treatment combination in children.