Effectiveness and Safety of Tofacitinib as Adjunctive therapy for DRESS: A Real-World Study.

Abstract

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe multisystem hypersensitivity reaction. While systemic glucocorticoids remain the cornerstone treatment, patients often exhibit resistance, intolerance, or relapse during tapering, highlighting an urgent need for effective strategies. To assess the effectiveness and safety of tofacitinib as an adjunctive therapy in patients with DRESS. We retrospectively analyzed patients with DRESS treated from January 2018 to June 2025, comparing systemic glucocorticoids alone versus glucocorticoids plus tofacitinib. Primary outcome was cumulative glucocorticoid exposure; secondary outcomes included clinical improvement and safety. We used multivariable regression and sensitivity analyses to adjust for potential confounding factors. Among 61 patients (37 [60.7%] female; 25 [41.0%] severe DRESS), adjunctive tofacitinib was associated with shorter time to near-complete rash resolution (median, 10.0 vs 13.5 days; p = 0.032), reduced glucocorticoid duration (58.0 vs 88.0 days; p < .001), and lower cumulative dose (1452.0 vs 2145.0 mg; p = 0.019). In adjusted analyses, tofacitinib remained associated with 24.9% reduction in glucocorticoid duration (p = 0.029). Six-month mortality was 0% versus 10.7% (p = 0.091). Adjunctive tofacitinib was associated with significant glucocorticoid-sparing effects in DRESS. Prospective randomized controlled trials are needed for validation.