Tofacitinib, a Janus kinase inhibitor approved to treat rheumatoid arthritis and bowel diseases, may allow patients with celiac disease to eat gluten without experiencing intestinal and extraintestinal symptoms. A case report published in Annals of Internal Medicine found tofacitinib to be effective for inducing remission in a patient with celiac disease, despite eating a gluten-containing diet.
Celiac disease, or gluten intolerance, requires a lifelong gluten-free diet, as no other non-dietary treatments have established efficacy. Dietary adherence is crucial for mucosal healing and prevention of long-term complications, but complete avoidance of gluten is difficult for even the most committed patients.
Researchers from University Hospitals Leuven, Leuven, Belgium describe the case of a male patient with celiac disease and alopecia. After achieving some remission following a gluten-free diet, the patient resumed eating gluten and had symptoms on and off, still suffering from alopecia. After discussing the risks and benefits, the patient decided on watchful waiting. He did not return to a gluten-free diet, but started off-label use of tofacitinib, 5 mg twice daily, for alopecia. Follow-up investigations unexpectedly showed complete histologic and serologic remission of celiac disease while he was still on a gluten-containing diet. The patient continued tofacitinib use, with regular blood tests showing normal complete blood count, lipid levels, and creatine kinase levels. While these results are encouraging for patients with celiac disease, the authors caution that potential side effects limit the use of tofacitinib to refractory disease only.
American College of Physicians