Tofacitinib

Tofacitinib is a Janus kinase (JAK) inhibitor, a group of intracellular enzymes involved in signalling pathways that affect haematopoiesis and immune cell function, used to treat rheumatic conditions, such as rheumatoid arthritis and ankylosing spondylitis, and ulcerative colitis.

Indications

Tofacitinib is indicated for the treatment of adult patients with moderately to severely active rheumatoid arthritis who have had an inadequate response or intolerance to Methotrexate. It may be used as monotherapy or in combination with methotrexate or other nonbiologic disease-modifying antirheumatic drugs (DMARDs).

Dosage

Oral; 5mg once daily

Contra-Indications

Tofacitinib is contraindicated in patients with: • Hypersensitivity to the active substance or to any of the excipients. • Active tuberculosis (TB), serious infections such as sepsis, or opportunistic infections. • Severe hepatic impairment. • Pregnancy and lactation.

Special Precautions

Paediatric: As there is a higher incidence of infections in the elderly population in general, caution should be used when treating the elderly Pregnancy: Women of childbearing potential should be advised to use effective contraception during treatment with tofacitinib and for at least 4 weeks after the last dose. Lactation: It is not known whether tofacitinib is secreted in human milk. A risk to the breast-fed child cannot be excluded. Tofacitinib was secreted in the milk of lactating rats. As a precautionary measure, the use of tofacitinib during breast-feeding is contraindicated. Elderly: Adverse reactions observed in pediatric patients receiving Tofacitinib were consistent with those reported in RA patients. Use in Diabetics: As there is a higher incidence of infection in diabetic population in general, caution should be used when treating patients with diabetes.

Side Effects

Serious Infections, mortality, Malignancy and Lymphoproliferative Disorders, Thrombosis, gastrointestinal perforations, hypersensitivity, liver enzyme abnormalities, anemia.

Drug Interactions

Fluconazole, Ketoconazole, Rifampicin, Tacrolimus, Azathioprine