Preliminary Observation of Tofacitinib in the Treatment of Primary Cutaneous Amyloidosis: A Single-Arm Clinical Trial

Background Primary cutaneous amyloidosis (PCA) lacks consensus-based therapeutic guidelines, with conventional modalities demonstrating suboptimal clinical responses. Objectives To assess the efficacy and safety profile of oral tofacitinib, a JAK1/3 inhibitor, in PCA management. Patients and Methods This single-center, open-label, single-arm prospective interventional study enrolled 20 PCA patients receiving tofacitinib 5 mg twice daily. Demographic parameters, disease characteristics (pruritus numeric rating scale [p-NRS], dermatology life quality index [DLQI], lesion severity [LS] scores), and adverse events were systematically recorded at baseline and weeks 2, 6, and 10 post-treatment. Results At week 10, significant reductions were observed across all endpoints: p-NRS: 6.90 ± 2.86 → 0.35 ± 0.59 (p < 0.001); DLQI: 11.75 ± 5.64 → 2.55 ± 2.49 (p < 0.001); LS: 13.25 ± 5.15 → 4.90 ± 2.40 (p < 0.001). Eleven patients (55%) achieved the primary efficacy threshold (≥60% LS improvement)，wiith no macular amyloidosis (MA). Two treatment-emergent adverse events (TEAEs) occurred: transient hepatobiliary enzyme elevations resolving with hepatoprotectants, and one self-limiting upper respiratory infection. Conclusion Tofacitinib demonstrates rapid anti-pruritic effects and sustained lesion clearance in PCA, with favorable tolerability. Study limitations including small sample size (n=20), 10-week duration, and uncontrolled design may constrain generalizability, warranting phase III trials for validation.