{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T20:28:51Z","timestamp":1786739331250,"version":"build-2736575974"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T00:00:00Z","timestamp":1744675200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The response of atopic dermatitis (AD) to different biologics and JAK inhibitors (JAKibs) is variable due to the varied immunological endotypes of AD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim and Objectives:<\/jats:title>\n                    <jats:p>To assess the effectiveness and adverse effect profile of tofacitinib in recalcitrant, moderate-to-severe AD patients and to compare the cost of therapy of tofacitinib with dupilumab.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods:<\/jats:title>\n                    <jats:p>We retrospectively analyzed records of moderate to severe AD treated with tofacitinib monotherapy. The response to tofacitinib was assessed using clinical scores including Numerical Rating Scale (NRS), Scoring Atopic Dermatitis (SCORAD), and Eczema Area and Severity Index (EASI) at 4 weeks and 8 weeks of treatment. We also analyzed the duration of remission and time after which recurrences were seen after stopping tofacitinib. The cost of tofacitinib was compared with dupilumab.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Twelve cases of recalcitrant moderate\u2013severe AD who had failed systemic agents [oral corticosteroids (n = 7), cyclosporine (n = 4), and azathioprine (n = 2)] were treated with tofacitinib monotherapy. There was a statistically significant reduction in SCORAD, EASI, and NRS scores at 4 weeks and 8 weeks of tofacitinib therapy [mean at baseline: 4 weeks: 8 weeks = SCORAD- 43.54: 22.74: 11.87 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.002); EASI-19.5: 6.45: 1.6 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.002); NRS-5.75: 3.25: 1.08 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.002)]. EASI 90 was achieved by 66% of patients in 8 weeks with treatment failure in one patient. The mean time to achieve complete\/near complete resolution (n = 8) of the disease was 6.1 weeks (3-8 weeks). Relapse of the disease was noted in 4\/11 (36.3%) patients. Side effects were observed in 5\/12 (41.6%) patients (herpes zoster, dyslipidemia, anemia, impetigo, and thrombocytosis). The cost of therapy with dupilumab is 122 times higher than that of tofacitinib therapy (8 weeks treatment).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Limitations:<\/jats:title>\n                    <jats:p>Small sample size and lack of tissue cytokines analysis pre- and post-treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Tofacitinib (pan JAK inhibitor) inhibits T helper 2 (Th2), Th1, Th17, and Th22 cell lines, and thus has potential for refractory AD. There is a need to generate tissue-based cytokine expression data in Indian patients with AD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/idoj.idoj_665_24","type":"journal-article","created":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T08:00:37Z","timestamp":1744704037000},"page":"420-425","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":5,"title":["A Real-World Study of Tofacitinib in Indian Patients with Refractory Moderate-to-Severe Atopic Dermatitis, its Economic Considerations and Immunological Rationale"],"prefix":"10.4103","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1757-3406","authenticated-orcid":false,"given":"Kabir","family":"Sardana","sequence":"first","affiliation":[{"name":"Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences and Research Institute and Dr. Ram Manohar Lohia Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Savitha","family":"Sharath","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences and Research Institute and Dr. Ram Manohar Lohia Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumitra Kumari","family":"Meena","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences and Research Institute and Dr. Ram Manohar Lohia Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ananta","family":"Khurana","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences and Research Institute and Dr. Ram Manohar Lohia Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhawuk","family":"Dhir","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences and Research Institute and Dr. Ram Manohar Lohia Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,4,15]]},"reference":[{"key":"R1-20250503","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1016\/j.jaci.2014.08.008","article-title":"Deciphering the complexities of atopic dermatitis:Shifting paradigms in treatment approaches","volume":"134","author":"Leung","year":"2014","journal-title":"J Allergy Clin Immunol"},{"key":"R2-20250503","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1067\/mai.2000.106484","article-title":"Atopic dermatitis:New insights and opportunities for therapeutic intervention","volume":"105","author":"Leung","year":"2000","journal-title":"J Allergy Clin Immunol"},{"key":"R3-20250503","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1093\/intimm\/dxf109","article-title":"Preferential expression of T (h) 2-type chemokine and its receptor in atopic dermatitis","volume":"14","author":"Uchida","year":"2002","journal-title":"Int Immunol"},{"key":"R4-20250503","doi-asserted-by":"crossref","first-page":"1344","DOI":"10.1016\/j.jaci.2012.07.012","article-title":"Progressive activation of T (H) 2\/T (H) 22 cytokines and selective epidermal proteins characterizes acute and chronic atopic dermatitis","volume":"130","author":"Gittler","year":"2012","journal-title":"J Allergy Clin Immunol"},{"key":"R5-20250503","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/j.jaci.2013.04.046","article-title":"Intrinsic atopic dermatitis shows similar TH2 and higher TH17 immune activation compared with extrinsic atopic dermatitis","volume":"132","author":"Su\u00e1rez-Fari\u00f1as","year":"2013","journal-title":"J Allergy Clin Immunol"},{"key":"R6-20250503","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1097\/ACI.0000000000000376","article-title":"Atopic dermatitis phenotypes and the need for personalized medicine","volume":"17","author":"Cabanillas","year":"2017","journal-title":"Curr Opin Allergy Clin Immunol"},{"key":"R8-20250503","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1111\/j.1365-2133.1994.tb08532.x","article-title":"The U. 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Independent hospital validation","volume":"131","author":"Williams","year":"1994","journal-title":"Br J Dermatol"},{"key":"R9-20250503","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/S0140-6736(22)01199-0","article-title":"Efficacy and safety of abrocitinib versus dupilumab in adults with moderate-to-severe atopic dermatitis:A randomised, double-blind, multicentre phase 3 trial","volume":"400","author":"Reich","year":"2022","journal-title":"Lancet"},{"key":"R10-20250503","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1001\/jamadermatol.2021.3023","article-title":"Efficacy and safety of upadacitinib vs dupilumab in adults with moderate- to-severe atopic dermatitis:A randomized clinical trial","volume":"157","author":"Blauvelt","year":"2021","journal-title":"JAMA Dermatol"},{"key":"R11-20250503","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/S0140-6736(20)30732-7","article-title":"Efficacy and safety of abrocitinib in adults and adolescents with moderate-to-severe atopic dermatitis (JADE MONO-1):A multicentre, double-blind, randomised, placebo-controlled, phase 3 trial","volume":"396","author":"Simpson","year":"2020","journal-title":"Lancet"},{"key":"R12-20250503","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1007\/s13555-022-00882-z","article-title":"Real-life effectiveness and safety of upadacitinib in adults and adolescents with moderate-to-severe atopic dermatitis:A single-center 16-week study","volume":"13","author":"Gargiulo","year":"2023","journal-title":"Dermatol Ther (Heidelb)"},{"key":"R13-20250503","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1001\/jamadermatol.2020.3260","article-title":"Efficacy and safety of baricitinib combined with topical corticosteroids for treatment of moderate to severe atopic dermatitis:A randomized clinical trial","volume":"156","author":"Reich","year":"2020","journal-title":"JAMA Dermatol"},{"key":"R14-20250503","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.alit.2021.07.003","article-title":"Subtypes of atopic dermatitis:From phenotype to endotype","volume":"71","author":"Tokura","year":"2022","journal-title":"Allergol Int"},{"key":"R15-20250503","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.cell.2017.08.006","article-title":"Sensory neurons co-opt classical immune signaling pathways to mediate chronic itch","volume":"171","author":"Oetjen","year":"2017","journal-title":"Cell"},{"key":"R16-20250503","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/j.jaci.2016.12.960","article-title":"Janus kinase inhibitors display broad anti-itch properties:A possible link through the TRPV1 receptor","volume":"140","author":"Fukuyama","year":"2017","journal-title":"J Allergy Clin Immunol"},{"key":"R17-20250503","doi-asserted-by":"crossref","first-page":"2955","DOI":"10.1007\/s00403-023-02707-1","article-title":"Use of tofacitinib in recalcitrant cases of chronic pruritus of unknown origin","volume":"315","author":"Sardana","year":"2023","journal-title":"Arch Dermatol Res"},{"key":"R18-20250503","doi-asserted-by":"crossref","first-page":"1298","DOI":"10.1016\/j.jaci.2017.10.046","article-title":"Minimally invasive skin tape strip RNA sequencing identifies novel characteristics of the type 2-high atopic dermatitis disease endotype","volume":"141","author":"Dyjack","year":"2018","journal-title":"J Allergy Clin Immunol"},{"key":"R19-20250503","doi-asserted-by":"crossref","first-page":"975","DOI":"10.2217\/imt-2022-0306","article-title":"Comparing how well abrocitinib and dupilumab treat atopic dermatitis signs and symptoms:A plain language summary","volume":"15","author":"Reich","year":"2023","journal-title":"Immunotherapy"},{"key":"R20-20250503","article-title":"World Health Organization Global Health Expenditure database. 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