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03 October 2018

Xeljanz (Tofacitinib) - First-of-its-kind Treatment Approved for Psoriatic Arthritis

NICE approves Xeljanz (Tofacitinib) for the treatment of psoriatic arthritis in adults in England and Wales.

The National Institute for Health and Care Excellence (NICE) has today published its decision to recommend the Janus Kinase (JAK) inhibitor Xeljanz (also known by its generic name, Tofacitinib) as a treatment option for adults with active psoriatic arthritis in England and Wales.

The guidance states that Xeljanz, with methotrexate, is recommended to treat psoriatic arthritis in the following circumstances:

  • The person has peripheral arthritis with three or more tender joints, and three or more swollen joints, and;
  • The psoriatic arthritis has not responded well to at least two standard disease-modifying antirheumatic drugs (DMARDs), given either alone or in combination.
  • The person has had a biologic from the tumour necrosis factor (TNF)-alpha inhibitor class (such as Adalimumab, Cimzia, EtanerceptInfliximab or Simponi) but their psoriatic arthritis has not responded within the first 12 weeks or has stopped responding after the first 12 weeks, or;
  • Biologics from the tumour necrosis factor alpha (TNF)-alpha inhibitor class are contraindicated (should not be used in this case) but would otherwise be considered

How does Xeljanz work?

Xeljanz is a Janus Kinase (JAK) inhibitor. It works differently to any of the other treatments that are currently available to treat psoriatic arthritis.

Cytokines are proteins that work in the immune system and play a key role in controlling cell growth and immune responses. It is thought that cytokines are over-active in people with psoriatic arthritis, leading to the overproduction of inflammation, which in turn causes the signs and symptoms of this condition. Cytokines rely on a family of enzymes known as Janus Kinase (JAK) enzymes, to help them distribute their messages. Xeljanz stops the activity of JAK enzymes, meaning that the inflammatory cycle of psoriatic arthritis is disrupted. This leads to an improvement in symptoms for many people who take Xeljanz.

How is Xeljanz used?

Xeljanz comes in a tablet form, and is taken orally twice a day, with or without food. Certain individuals may have circumstances meaning that their dose needs to be adjusted. If this is the case, you should follow the instructions that your doctor gives you regarding how much to take and when. Xeljanz is used in combination with methotrexate, rather than on its own. It is important to note that methotrexate is usually taken once a week, whereas the Xeljanz tablet is twice a day. It may be helpful to keep them separately in order to avoid any confusion.

People taking Xeljanz will have regular blood tests every three months - usually carried out by Dermatology or Rheumatology Nurses, or by their own GP - to monitor for possible effects of the treatment.

For more information on Xeljanz, have a read of our information sheet.