The Medical Letter on Drugs and Therapeutics
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1407
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Tofacitinib (Xeljanz) for Rheumatoid Arthritis

The FDA has approved tofacitinib (toe” fa sye’ ti nib; Xeljanz – Pfizer), an oral Janus kinase (JAK) inhibitor, for treatment of adults with moderately to severely active rheumatoid arthritis (RA) who have had an inadequate response to or are intolerant of methotrexate. Ruxolitinib (Jakafi) is the only other JAK inhibitor available in the US; it is FDA-approved for treatment of myelofibrosis.1

TREATMENT OF RHEUMATOID ARTHRITIS — For initial treatment of RA, most expert clinicians prescribe a disease-modifying antirheumatic drug (DMARD), and add a nonsteroidal anti-inflammatory drug (NSAID) with or without a corticosteroid to control symptoms. Methotrexate is generally the DMARD of choice; hydroxychloroquine is a safer alternative that may be appropriate in the mildest cases. Tumor necrosis factor (TNF) inhibitors are typically the first-line biologic ... more      

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