National Institute for Health and Care Excellence (NICE) has recommended tofacitinib (Xeljanz) for treatment of moderate to severe rheumatoid arthritis.
Tofacitinib is recommended as a treatment option for adults with active rheumatoid arthritis not responding adequately to one or more disease-modifying anti-rheumatic drugs (DMARDs), or those who have a contraindication for other DMARDs including at least 1 biological drug (usually rituximab). The drug is to be used if the disease is severe as defined by disease activity score (DAS28)>5.1. Patients with intolerance or contraindication for methotrexate can receive tofacitinib as monotherapy.
Recommended dose for tofacitinib is 5 mg twice daily. The frequency should be reduced once daily for those with severe renal impairment or moderate hepatic impairment. Severe hepatic impairment is a contraindication for tofacitinib.
Treatment with tofacitinib beyond 6 months should only be continued only in case of a moderate clinical response measured using European League Against Rheumatism (EULAR) criteria.
The drug is to be used only when it discounted by the company in agreement with the patient access scheme. The recommendation should not affect patients whose treatment with the drug was started before publication of the guidance.