Could an Old Arthritis Drug Treat Celiac Disease and Allow Celiacs to Eat Gluten Again?

Celiac.com 08/17/2020 - The case of a man whose celiac disease went into remission after he took an off market drug for alopecia, even though he was eating gluten, is getting some attention from researchers.

An alopecia patient at the University Hospitals Leuven, Belgium, tried to control his celiac disease by following a gluten-free diet. After some modest improvement in symptoms, the patient returned to a non-gluten-free diet, and the symptoms returned. 

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The patient chose to continue eating gluten, and to keep an eye on the symptoms. At about that time, he began taking off-label Tofacitinib to treat his alopecia. 

Tofacitinib is a Janus kinase inhibitor approved for treatment of rheumatoid arthritis and bowel diseases. Tofacitinib inhibits enzymes associated with symptoms of rheumatoid arthritis, but it’s also used to treat alopecia and certain bowel diseases.

To the surprise of his clinicians, a follow-up visit showed complete histologic and serologic remission of the man's celiac disease, despite his ongoing consumption of gluten. Blood tests for celiac antibodies all came back in the normal range.

The result is intriguing, but is only a single case, and it will require a larger study to reveal whether this might also work in others with celiac disease. Since Tofacitinib has already been approved by the FDA as a safe and effective treatment for several non-celiac conditions, positive studies of it successfully treating celiac disease could mean that people with celiac disease may soon have a new drug option to manage their condition.

Still, this case report is only one single patient, and much more research needs to be done before drawing any conclusions about whether this drug will work in others with celiac disease. The clinicians are encouraging further study of the relationship between Tofacitinib and celiac disease remission. At the same time, they advise caution, because Tofacitinib can have potentially serious side effects, and may not be suitable for long-term use. In fact, if Tofacitinib proves useful against celiac disease, it may be especially helpful for people with refractory celiac disease.

Read more about the team's report in Annals of Internal Medicine