Tofacitinib (Xeljanz)

Indications

  • Rheumatoid Arthritis (RA) (see Rheumatoid Arthritis, [[Rheumatoid Arthritis]]): demonstrated to improve control over that of methotrexate alone (see Methotrexate, [[Methotrexate]]) [MEDLINE]
    • Used with/without methotrexate or other disease modifying agents

Contraindications


Pharmacology

  • Janus Kinase (JAK) Inhibitor

Administration

  • Pre-Administration Testing
    • Testing for Latent Tuberculosis
    • Testing for Viral Hepatitis: patient with hepatitis B/C were excluded from trials, so the effect of tofacitinib on viral reactivation of hepatitis B/C is unknown
  • xxxx

Adverse Effects

Endocrinologic Adverse Effects

Gastrointestinal Adverse Effects

  • Elevated Liver Function Tests (LFT’s) (see xxxx, [[]])
  • Intestinal Perforation (see Intestinal Perforation, [[Intestinal Perforation]]): although this has been reported in clinical trials, the etiologic role of tofacitinib is unknown

Infectious Adverse Effects

  • Increased Risk of Tuberculosis (see Tuberculosis, [[Tuberculosis]]) [MEDLINE]
    • Especially with concomitant use of other immunospppressants (such as methotrexate) and corticosteroids
  • Increased Risk of Invasive Fungal Infections: especially with concomitant use of other immunospppressants (such as methotrexate) and corticosteroids
  • Increased Risk of Other Opportunistic Infections: especially with concomitant use of other immunospppressants (such as methotrexate) and corticosteroids

Hematologic-Oncologic Adverse Effects

  • Anemia (see Anemia, [[Anemia]])
  • Lymphopenia/Leukopenia/Neutropenia (see Leukopenia, [[Leukopenia]] and Neutropenia, [[Neutropenia]])
  • Increased Risk of Malignancy
    • Epstein-Barr Virus (EBV)-Associated Lymphoproliferative Disease (see Epstein-Barr Virus, [[Epstein-Barr Virus]])
      • Cases reported in renal transplant patients who also received mycophenolate, corticosteroids, and basiliximab
    • Lymphoma (see Lymphoma, [[Lymphoma]])
    • Solid Malignancies

Other Adverse Effects

  • xxxx

References

  • Tofacitinib (CP-690,550) in combination with methotrexate in patients with active rheumatoid arthritis with an inadequate response to tumour necrosis factor inhibitors: a randomised phase 3 trial. Lancet. 2013 Feb 9;381(9865):451-60 [MEDLINE]
  • Tofacitinib in Combination With Nonbiologic Disease-Modifying Antirheumatic Drugs in Patients With Active Rheumatoid Arthritis: A Randomized Trial. Ann Intern Med. 2013;159(4):253-261 [MEDLINE]