Title : Tofacitinib versus Azathioprine in the management of chronic actinic dermatitis - A clinical trial
Abstract:
Background: Chronic actinic dermatitis (CAD) is an immunologically mediated photodermatosis characterized by pruritic eczematous and lichenified plaques located predominantly on sun-exposed areas.
Aims and Objectives: To compare the efficacy and tolerability of Tofacitinib with Azathioprine in the treatment of CAD.
Materials and Methods: 30 clinically diagnosed cases of CAD above 18 years of age were selected.15 patients were given Tb.Tofacitinib 5mg twice a day and 15 patients were given Tb.Azathioprine 50mg twice a day for 3 months. All those fulfilling the inclusion criteria had got all baseline investigations done.The first and second follow up was conducted after 15 and 30 days respectively, followed by once monthly visits, making a total of 4 follow up visits for each patient in each group. CBC,LFT and RFT were repeated at every visit. Clinical and Dermoscopic photos were taken at each visit. The efficacy of the drugs were evaluated on the basis of Visual Analog Scale(VAS),Pruritis Numerical Rating (PNR) score and Eczema Area and Severity Index (EASI)Score.
Results and Limitations: There was 56.5% reduction in the mean VAS score,59% reduction in the PNR score and 54% improvement in the EASI score at the end of the study in the Tofacitinib group whereas there was 38.5% reduction in VAS score,15% in the PNR score and 30% reduction in EASI score in the Azathioprine group. The p-value of the study was 0.018 (significant). There was derangement in the lipid profile of two patients at the end of the study amongst those taking tofacitinib while two patients developed transaminitis and two developed myelosuppression in the azathioprine group.
Conclusions: Tofacitinib is an effective and better tolerated drug as compared to Azathioprine in the treatment of CAD.
