Volume 86 - 2023 - Fasc.3 - Letters
Tofacitinib, celiac disease and the elderly: mind the gut!
To the Editor,
We read with great attention the interesting case
report by Lenfant et al. narrating the successful use of
tofacitinib in a patient with microscopic colitis and celiac
disease (1), and we would point some insights about this
peculiar situation.
In fact, tofacitinib depicts potential side effects,
including a higher risk of malignancies, and the FDA
has even issued a warning about this drug’s hazard (2).
Actually, a randomized open-label trial published in
the New England Journal of Medicine in 2021 found that
patients with rheumatoid arthritis who took tofacitinib
had a higher risk of developing cancer than those who
took a tumor necrosis factor (TNF) inhibitor (3).
Recently, two recent randmoized controlled trials from
the ORAL Surveillance Trial and published in the Annals
of the Rheumatic Diseases in 2023 also contributed to
shed the light on this potential risk : that patients with
rheumatoid arthritis aged > 50 with cardiovascular risk
who took tofacitinib had a higher risk of developing any
type of cancer than those who took a TNF inhibitor (4),
and secondary stratification found that they were more
likely to develop cancer if they were over the age of 65
years (5).
Adding insult to injury, the maligancies are also driven
by the two peculiar forms of celiac disease : seronegative
and refractory celiac disease (RCD), and this risk is also
increased in CD diagnosed at adulthood : particularly,
elder patients are prone to present a RCD, and giving
immune checkpoint therapy might increase this risk (6).
In conclusion, RCD ought to be definetly ruled out
before starting JAK inhibitor therapy, especially in
aged population with seronegative celiac disease and
microscopic colitis, two well-known conditions associated
with RCD.
