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

BACKGROUND: 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. OBJECTIVE: To assess the effectiveness and safety of tofacitinib as an adjunctive therapy in patients with DRESS. METHODS: 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. RESULTS: 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). CONCLUSION: Adjunctive tofacitinib was associated with significant glucocorticoid-sparing effects in DRESS. Prospective randomized controlled trials are needed for validation.