Tofacitinib

 

What is Tofacitinib?

Tofacitinib is a targeted DMARD (Disease modifying anti-rheumatic drug), which works to dampen down the body’s inflammatory response. In certain diseases the immune system is over active, this can target healthy tissues such as joints. Tofacitinib works on the inflammatory pathway to inhibit proteins called JAK, reducing the symptoms you should get from arthritis such as pain and joint swelling.

Tofacitinib is known as a JAK inhibitor from its effects, there are other medications in this group such as baricitinib.

 

What is Tofacitinib used for?

Tofacitinib is used in patients with rheumatoid arthritis and psoriatic arthritis where their joints are very active and not responding to 2 or more conventional DMARDs. It is usually given alongside some of these medications such as methotrexate.

Tofacitinib has also been found to help reduce the rash in psoriasis and your help your bowel in inflammatory bowel disease.

 

How is it taken? 

Tofacitinib is taken as a tablet twice a day. It can be taken with or without food. The dose is 5mg twice daily, however you may be recommended to just take it once a day depending on how well your kidneys work.

If you miss a dose, take it as soon as you remember that day, but never double up the dose.

 

The effects from tofacitinib are usually seen to start within a week and build up, so we usually continue for 12 weeks before we review how well it is working. You will be seen in clinic at this time to monitor how well you are doing.

 

You will require blood monitoring of the medication every 8 weeks when you start taking the tablets for the first 4 months. This monitoring is dropped down to every 3 months whilst you continue on it. If you are on other medications such as other DMARDs, the blood monitoring can be carried out at the same time.

 

Side effects

Tofacitinib is usually well tolerated by patients, however a small number of patients may experience some side effects such as feeling sick and headaches in the first few weeks of starting. These usually settle down after the first few weeks.

There are a few conditions that tofacitinib has been found to make you slightly more susceptible to, these include:

 

• Infections
  • Including reactivation of shingles or chicken pox
    • You will need to speak to your GP about getting treatments for these. Tofacitinib should be stopped until your infection has cleared up.
• High cholesterol
  • This will be checked at your 8-week blood test and if raised you may need to start treatment such as a statin.
• Liver derangement
  • Occasionally tofacitinib affects the liver blood tests, this has been found to be more common if you are taking methotrexate.
• Risk of cancer
  • Tofacitinib is a new drug so there isn’t as much long-term data. From trials there hasn’t been an observed link to say that tofacitinib causes cancer.
    • If at any point you are under investigation you need to let your consultant know.
• Non malignant skin cancer
  • There may be a small increased risk of developing non-spreading skin cancer, try to reduce this risk by taking care in the sun and monitoring your skin.
• Bowel problems
  • Tofacitinib can sometimes cause problems with your bowel, if you notice any change in your movements or experience blood or pain, speak to your doctor or nurse specialist.

 

Cautions of use

Interactions with other medications

• Your doctor will check if there are any medications that could interact. You can carry on taking your usual painkillers including NSAIDs.

Contraindications of other conditions

• Before starting any biological therapy, your bloods will be checked for infections that can become active again when the immune system is suppressed, this includes hepatitis B, C and HIV. A blood and chest X-ray is taken to exclude previous TB exposure. If you are found to have had previous TB exposure you may need to start preventative antibiotics for a short period before the tofacitinib is commenced.

Operations

• Tofacitinib should be stopped 1 week before planned surgery.

During pregnancy and breastfeeding

• There is limited data on tofacitinib in pregnancy and breastfeeding, therefore it is recommended to use contraception whilst taking it and for 4 weeks after stopping.

Alcohol

• Alcohol and tofacitinib can both affect the liver. It is recommended to take alcohol within moderation, following the guidelines of less than 14 units weekly.

Vaccinations

• Flu and the pneumonia vaccine are safe and recommended whilst taking tofacitinib.
• Live vaccines including the shingles vaccine should not be given due to the dampening down of the immune system.

 

Useful Links

Versus Arthritis: http://www.versusarthritis.org