What is tofacitinib?

Why is tofacitinib prescribed?

What are the possible side effects?

What are the risks?

What else should I know about tofacitinib?

What is tofacitinib?

Tofacitinib is a type of drug known as a JAK inhibitor.

What are the brand names of tofacitinib?

The originator drug is Xeljanz.

What does it do?

It works by blocking the action of Janus kinase enzymes, which are involved in the inflammation that causes the symptoms of rheumatoid arthritis and psoriatic arthritis.

Tofacitinib is a long-term treatment. Most people who benefit from this treatment will notice an improvement the first 12 weeks of starting treatment.

What is it used for?

Tofacitinib can be prescribed by a consultant rheumatologist for adults with rheumatoid arthritis or psoriatic arthritis.

How is it taken?

Tofacitinib is taken as tablets that can be taken with or without food. The usual dose is two tablets a day – one in the morning and one in the evening. But your doctor may suggest taking just one tablet a day.

Are there any side-effects?

Because tofacitinib affects your immune system, it can make you more likely to pick up infections. These include throat, nose and chest infections, cold sores, skin infections (cellulitis) and urinary tract infections. There seems to be a particular risk of shingles (a skin infection caused by the chicken pox virus) in people who take JAK inhibitors.

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Why is tofacitinib prescribed?

Tofacitinib is prescribed by a consultant rheumatologist for adults with rheumatoid arthritis or psoriatic arthritis.

These drugs work by interfering with the inflammatory processes within the immune system that cause the symptoms of rheumatoid arthritis.

Is there any reason I will not be prescribed tofacitinib?

Tofacitinib won’t be started if:

• your arthritis isn’t active
• you haven’t tried other treatments appropriate for your condition first
• you are pregnant or planning to try for a baby.

Your doctor may decide not to prescribe this treatment if you have or have had:

• an infection
• shingles
• lung disease
• hepatitis or other liver problems, or kidney disease
• heart problems, high blood pressure or high cholesterol
• stomach ulcers

How long does tofacitinib take to work?

Tofacitinib is a long-term treatment. Most people who benefit from this treatment will notice an improvement within four weeks of starting treatment, but further improvements may be seen over the first six months of treatment.

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What are the possible side effects?

Some people who take tofacitinib will develop reductions in white blood cells, raised liver blood tests and raised levels of cholesterol in the blood. These problems are usually mild, but your rheumatology team will arrange regular blood checks while you are taking tofacitinib as a precaution.

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What are the risks?

Tofacitinib and the other JAK inhibitors are a relatively new group of medicines. Because of this, we know less about the risk of longer-term side effects. Because tofacitinib affects your immune system, it can make you more likely to pick up infections. These include throat, nose and chest infections, cold sores, skin infections (cellulitis) and urinary tract infections. There seems to be a particular risk of shingles (a skin infection caused by the chicken pox virus) in people who take JAK inhibitors.

You should always read the latest patient information leaflet included with your medicines package to keep you informed about any possible side effects of your prescribed medications.

Will it affect vaccinations?

It’s best to discuss vaccinations with your doctor and, if possible, to have any vaccinations you may need before starting tofacitinib. It’s generally recommended that people on tofacitinib avoid live vaccines. These include measles, mumps and rubella (MMR), tuberculosis (BCG), yellow fever and shingles. Pneumococcal vaccines, which help to protect against pneumonia, and yearly flu vaccines – except the nasal flu vaccine – are fine and are usually recommended.

Can I drink alcohol while on tofacitinib?

There’s no known interaction between tofacitinib and alcohol, so it’s fine to have a drink if you’re taking this medication. However you should follow The recommended weekly low-risk alcohol guidelines, which are less than 11 standard drinks for women, and 17 standard drinks for men

Does tofacitinib affect fertility or pregnancy?

At present, we know very little about the effects of tofacitinib in pregnancy. To be on the safe side, tofacitinib isn’t recommended if you’re pregnant or planning a pregnancy. If you could become pregnant, you should use effective contraception while being treated with tofacitinib and for at least four weeks after stopping the treatment.

There’s currently no information on whether tofacitinib might affect male or female fertility.

Does it affect breastfeeding?

It’s not yet known whether tofacitinib passes into breastmilk, so breastfeeding isn’t generally recommended if you’re on tofacitinib.

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What else should I know about tofacitinib?

Other side effects of tofacitinib include nausea, increase the risk of blood clots (deep vein thrombosis and pulmonary embolism), slightly increased risk of some cancers and it can sometimes cause stomach or bowel problems

 Rarely, tofacitinib can cause an allergic reaction with sudden swelling, a rash or breathlessness. If you do develop these symptoms, or any other severe symptoms while taking tofacitinib, you should see k medical advice immediately.

Will I need any special checks while on tofacitinib?

You’ll have blood tests before treatment starts to assess your condition and whether the drug is suitable for you. Your rheumatology team will also monitor you through blood tests once you start treatment. If your red or white blood cell count gets too low, your treatment may be stopped until it improves. Your doctor will need to check if you’ve previously been exposed to tuberculosis (TB). Even if you don’t have symptoms, the bacteria that cause TB may still be present in the body and you may need a course of treatment for this before starting tofacitinib.

If you’ve previously had hepatitis you may need regular checks for this as tofacitinib may increase the risk of the hepatitis coming back. You may have to be monitored for other conditions as well, for example if you have liver problems, high cholesterol, or if you are at risk of heart or lung conditions. Tofacitinib raises cholesterol levels in some people.

Can I take other medicines alongside tofacitinib?

Many people take methotrexate as well as tofacitinib. However, some drugs may interact with tofacitinib, so check with your doctor before starting any new medicines, especially if you’re taking medicines to treat bacterial or fungal infections. And remember to mention you’re on tofacitinib if you’re treated by anyone other than your usual rheumatology team.

You may be more likely to develop a serious infection if you’re taking tofacitinib alongside steroid treatments or other drugs that affect the immune system.

You can carry on taking painkillers and NSAIDs, if needed, unless your doctor advises otherwise.

You shouldn’t take over-the-counter or herbal medicines without discussing it first with your rheumatology team.

Can I continue with tofacitinib if I am going to have an operation?

If you’re thinking about having surgery, talk this over with your healthcare team. They may advise you to stop tofacitinib for a time before and after surgery.

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