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Lack of efficacy in critical condition and off-label use: case report A 68-year-old man exhibited lack of efficacy during treatment with prednisone and cyclophosphamide for eosinophilic fasciitis. Later, he received off-label treatment with tofacitinib for the eosinophilic fasciitis. The man started developing skin pitting oedema and erythema affecting the bilateral forearms and calves in July 2017. Concomitantly, he experienced mucocutaneous itching and desquamation. The lesions were gradually replaced by sclerosis. Constitutional symptoms included weight loss and asthenia. After evaluation, he was diagnosed with eosinophilic fasciitis. Therefore, he started receiving treatment with oral prednisone 30mg for one month and tapered at the rate of 10% dosage reduction every week. However, skin induration continued to progress. He also developed numbness of extremities beyond the bilateral knees and elbow joints. Hence, in March 2018, his treatment was started with oral cyclophosphamide 100mg every alternate day; however, no improvement was noted in his condition. In May 2018, he reported a new complaint of difficulty in dorsiflexion of the foot. Eventually, he was hospitalised with skin pitting oedema and erythema affecting the bilateral forearms and calves on 11 June 2018. After various examinations, and due to continued progression of disease on prednisone and cyclophosphamide, he was suggested off-label treatment with tofacitinib. After he agreed to the off-label tofacitinib therapy, he started receiving oral tofacitinib 5mg twice daily. Cyclophosphamide was stopped and prednisone was tapered quickly. Complete recovery was noted in his condition after 5 months of treatment. Cao X-Y, et al. Janus kinase inhibitor tofacitinib is a potential therapeutic option for refractory eosinophilic fasciitis. Clinical and Experimental Rheumatology 38: 567-568, 803519762 No. 3, May 2020. Available from: URL: https://www.clinexprheumatol.org/abstract.asp?a=14738

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Reactions 5 Dec 2020 No. 1833