Tags
cytokine, interleukin, jak, janus kinase, joints, ra, rheumatoid arthritis, synovitis, tyrosine kinase
XELJANZ ® (tofacitinib) is the new rheumatoid arthritis drug on the market and it is made by Pfizer.
Important points about Xeljanz to remember are:
– It is a biologic therapy therefore infections can occur.
– Therapy should be stopped in case of infection.
– Patients should be screened for TB prior to start of therapy and monitored periodically afterwards.
– It should be used with caution in those with history of diverticulitis.
– No information is available for use in patients with chronic hepatitis B or hepatitis C.
– Monitoring by blood testing is needed for possible effects on blood counts specifically hemoglobin, lymphocytes, neutrophils, liver enzymes, Creatinine, and lipids.
– Xeljanz dose should be reduced to 5 mg daily in patients with moderate liver or kidney involvement and not used in severe liver disease.
– The dose should also be reduced to 5 mg daily in patients on potent inhibitors of Cytochrome P450 3A4 (CYP3A4) (e.g., ketoconazole) and CYP2C19 (e.g., fluconazole).
– Use of live vaccine in patients should be avoided as has not been studied and there were reports of reactivation of herpes zoster in the clinical trials.
– No information is available in terms of multiple sclerosis
– It was recently rejected by european equivalent of FDA as they felt the risks were more than the benefits.
