Tofacitinib Hypothesis-generating, Pilot Study for Corticosteroid-Dependent Sarcoidosis

Primary Objectives:

Objective 1: Test the hypothesis that the addition of tofacitinib will allow patients with
sarcoidosis to have 50% or greater reduction in their corticosteroid requirement without a
significant decrease in pulmonary function testing, and with a similar quality of life as
measured by a validated questionnaire (1).

Objective 2: Test the hypothesis that the addition of tofacitinib will result in
significantly decreased expression of signal transducer and activator of transcription
(STAT)-1 dependent gene expression.

Outline:

This is a 16-week open-label, interventional, proof of concept, hypothesis-generating study.
All subjects will receive Tofacitinib 5mg twice daily for 16 weeks. After four weeks on
Tofacitinib, the corticosteroid will be tapered per a pre-defined protocol; once a reduction
of 50% has been achieved, any further taper will be per physician discretion. After 16 weeks,
subjects who meet the primary end-point will be permitted an optional one year open-label
extension.

Inclusion Criteria:

- Meet World Association of Sarcoidosis and other Granulomatous Disorders (WASOG)
definition of pulmonary sarcoid

- Histologically proven sarcoid

- Evidence of pulmonary sarcoid on chest radiograph

- FVC of > 50%

- Require 15-30mg/day of prednisone or equivalent corticosteroid to control sarcoidosis.

- Stable dose of prednisone or equivalent corticosteroid for 4 weeks prior to
enrollment.

Exclusion Criteria:

- May be taking methotrexate but not other immunosuppressive or immunomodulatory
treatments in the two months prior to study period. This includes but is not limited
to azathioprine, cyclophosphamide, leflunomide, mycophenolate mofetil, cyclosporine,
tacrolimus, and biologic medications.

- Patients requiring >30mg/day prednisone or equivalent.

- Pregnant or lactating women.

- Hemoglobin < 9g/dL or hematocrit < 30%

- White blood cell count <3.0 K/cu mm

- Absolute neutrophil count <1.2 K/cu mm

- Platelet count <100 K/cu mm

- Subjects with an estimated glomerular filtration rate (GFR) ≤40 ml/min

- Subjects with a total bilirubin, aspartate aminotransferase (AST), or alanine
aminotransferase (ALT) more than 1.5 times the upper limit of normal at screening.

- Severe, progressive, or uncontrolled chronic liver disease including fibrosis,
cirrhosis, or recent or active hepatitis.

- History of any lymphoproliferative disorder such as Epstein Barr virus (EBV) related
lymphoproliferative disorder, history of lymphoma, leukemia, or signs and symptoms
suggest of current lymphatic disease.

- Current malignancy or history of malignancy, with the exception of adequately treated
or excised non-metastatic basal cell or squamous cell cancer of the skin, or cervical
carcinoma in situ.

- Have or have had an opportunistic infection (e.g., herpes zoster [shingles],
cytomegalovirus, Pneumocystis carinii, aspergillosis and aspergilloma, histoplasmosis,
or mycobacteria other than TB) within 6 months prior to screening.

- Have a known infection with human immunodeficiency virus (HIV)

- Have current signs and symptoms of systemic lupus erythematosus, or severe,
progressive, or uncontrolled renal, hepatic, hematologic, endocrine, pulmonary,
cardiac (New York Heart Association class III or IV), neurologic, or cerebral diseases
(with the exception of sarcoidosis).