Tofacitinib
Tofacitinib
- Pregnancy category C
- Xeljanz
- Topical, oral
- JAK1/3 >>2
FDA
- Psoriatic arthritis
- Rheumatoid arthritis
- Ulcerative colitis
Off-label
- Atopic dermatitis
- Psoriasis (not approved yet due to side effects with the 10 mg twice daily dose)
- Alopecia areata (recurrence of alopecia areata observed after discontinuation)
- Vitiligo
- Systemic lupus erythematosus
Reports
- Discoid lupus
- Diffuse systemic sclerosis
- Sjögren syndrome
- Chronic actinic dermatitis
- Hypereosinophilic syndrome
- Idiopathic erythema multiforme
- Cutaneous sarcoidosis
- Dermatomyositis
- Diffuse systemic sclerosis
- SAPHO (synovitis, acne, pustulosis, hyperostosis & osteitis)
Boxed warning
- Serious infections & malignancy
Infections
- Nasopharyngitis & upper respiratory tract infections (most common), bacterial, fungal, viral & opportunistic infections
Cardiovascular
- Bradycardia & prolonged PR- interval, thromboembolic events
Pulmonary
- Interstitial lung disease (caution with methotrexate)
Gastrointestinal
- Perforation (caution with nonsteroidal anti-inflammatory drugs)
Cutaneous
- Non-melanoma skin cancers (report of aggressive cutaneous squamous cell carcinoma), Melanoma, Varicella zoster reactivation, pruritus, acne, aphthous ulcers, drug eruptions
Laboratory changes
- Anemia
- Lymphopenia
- Neutropenia
- Transaminitis
- Hyperlipidemia
- Increased creatinine
- Strong CYP3A4 inhibitors increase toxicity
- Avoid combination with immunosuppressive agents due to increased risk of complications
Baseline
- Complete blood count with differential
- Electrolytes
- Liver function tests
- Lipid profile
- Hepatitis B & C
- Tuberculosis evaluation
- Pregnancy test
Follow up
- Annual physical exam for skin cancers
- Monitor for signs/symptoms of infections including tuberculosis
- Complete blood count with differential
- Liver function test
- Lipid profile
- Repeat labs every 4-8 weeks after initiation, then every 3 months
Notes
- Discontinue if lymphocyte <500 or ANC <500
- Interrupt dose if hemoglobin drop >2g or <8g/dl
- Avoid live vaccines