The National Institute for Health and Care Excellence (NICE) recommends tofacitinib (Xeljanz) in combination with methotrexate as a treatment option for patients with active psoriatic arthritis who have inadequately responded or have been intolerant to previous DMARD therapy.
Tofacitinib is recommended for the treatment of adults with active psoriatic arthritis if the following conditions are fulfilled:
- The drug is used in agreement with NICE's technology appraisal guidance on etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis.
- Patient had no response within the first 12 weeks or had stopped responding after the first 12 weeks to a previous therapy of a TNF-alpha inhibitor.
- TNF-alpha inhibitors are contraindicated but would otherwise be considered.
Recommended dose for tofacitinib is 5 mg twice daily taken orally. Dose adjustment is not required when used with methotrexate. In case of a serious infection, therapy should be interrupted until the infection is controlled. Therapy should be discontinued if psoriatic arthritis has not responded adequately after 16 weeks. An adequate response is defined as an improvement in at least 2 of the 4 Psoriatic Arthritis Response Criteria, 1 of which must be joint tenderness or swelling score, with no worsening in any of the 4 criteria.
The drug is to be used only when provided by the company in agreement with the commercial arrangement. The recommendations should not affect patients whose treatment with the drug was started before publication of the guidance.
