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Inflammatory Bowel Disease
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Tofacitinib: This drug is used mostly in rheumatoid arthritis and appears to be effective in treating UC. Safety data for pregnancy and lactation is inadequate and tofacitinib is not recommended for use in pregnancy or with breastfeeding [85, 101].
Emerging Oral Treatments: Oral JAK Inhibitors for Alopecia Areata
Published in Rubina Alves, Ramon Grimalt, Techniques in the Evaluation and Management of Hair Diseases, 2021
Jared Marc John, Rodney Sinclair
Despite the lack of high-quality evidence to date, oral JAK inhibitors have demonstrated to be a safe and effective therapeutic option for AA with no differences in efficacy reported among the various JAK inhibitors studied [1]. Tofacitinib dosages of 5–10 mg twice daily were commonly prescribed with those on higher dosages experiencing accelerated hair regrowth and no increase in AEs [19, 20, 32]. Based on current literature, 5 mg twice daily appears to be sufficiently efficacious but may be uptitrated to 10 mg twice daily or more if required. Dosages of ruxolitinib 15 mg to 20 mg twice daily and baricitinib 4 mg to 11 mg daily were effective for significant hair regrowth. Dose reduction is required for tofacitinib and ruxolitinib in renal or hepatic impairment, or with concurrent administration of cytochrome p450 (CYP) CYP3A4 and CYP2C9 inhibitors, such as ketoconazole and clarithromycin [52]. Baricitinib is metabolized independently of the CYP system and is renally excreted [9].
Gastrointestinal disease
Published in Catherine Nelson-Piercy, Handbook of Obstetric Medicine, 2020
There are even fewer data for the small molecules, Janus kinase (JAK) inhibitors. Tofacitinib is used to treat rheumatoid arthritis, psoriatic arthritis and IBD. It is contraindicated in those at increased risk of pulmonary embolus, which would include pregnant patients. Data from those who conceive while taking it do not suggest an increased risk of adverse pregnancy outcomes.
Safety of current systemic therapies for nail psoriasis
Published in Expert Opinion on Drug Safety, 2023
Jonathan K. Hwang, Shari R. Lipner
Prior to initiation of tofacitinib, patients should be screened for tuberculosis, hepatitis, and HIV, as well as vaccination with recombination zoster vaccine considered [82]. Laboratory studies, including CBC, CMP, and lipid panels should be obtained at baseline and at 4–8 weeks after initiation of therapy, followed by monitoring every 3 months thereafter [87]. There are no controlled studies in pregnant women, but birth defects were reported in animal studies [75]. Data for pediatric patients is limited, but open-label psoriasis studies, as well as trials for alopecia areata and juvenile idiopathic arthritis, have demonstrated safety profiles similar to that of adults, but long-term data is still lacking [92]. For older patients (>65 years), clinical trials have shown increased risk of herpes zoster and serious infections compared to younger patients (<45 years) [78].
Potential application of mass spectrometry imaging in pharmacokinetic studies
Published in Xenobiotica, 2022
Chukwunonso K. Nwabufo, Omozojie P. Aigbogun
Recently, Huizing et al. investigated the suitability of MALDI-MSI to quantitatively visualise an FDA-approved drug, tofacitinib. Tofacitinib is used as a therapeutic agent for rheumatoid arthritis and ulcerative colitis. A single oral dosing of tofacitinib to rats was followed by 1 h and 7 h post-dosing MSI of the ileum, proximal, and distal colon. Tofacitinib was found to be distributed mostly in the ileum at 1 h post-dosing, while mostly distributed in the colon at 7 h post-oral dosing. The authors combined a 3 D intensity plot with haematoxylin and eosin (H&E) stains to validate the ability of MSI to differentiate between the lumen and intestinal wall layers and high exposure of drug in the muscular layer of the proximal colon (Huizing et al. 2021; Spruill et al. 2022).
Two cases of rheumatoid arthritis complicated by organising pneumonia successfully treated with tofacitinib therapy
Published in Modern Rheumatology Case Reports, 2021
Takao Kodera, Tomomi Tsutsumi, Yumiko Oka, Tomoki Takeda, Yuko Shirota, Junichi Kameoka
Tofacitinib suppresses the JAK signal and multiple inflammatory cytokines and exerts its effectiveness. However, the exact mechanisms by which tofacitinib was effective for OP are still speculative. Kawasumi et al. reported that interferon(IFN)-α, IL-1β, IL-6, IL-8, and IFN-γ-inducible protein 10 were significantly elevated in the serum of OP patients with RA [17]. On the other hand, tofacitinib could suppress IL-7, IL-15, IL-21, IL-6, IFN-α/β, and IL-10 through JAK 1 and 3 inhibition [12]. These multiple suppressed cytokines partially overlap with the elevated cytokines observed in OP patients, especially IFN-α and IL-6. Suppression of two or more cytokines may prevent the activation of alternative pathways of inflammation or block the possibility that alternative pathways lead to much stronger inflammation. Such effects also appear to resemble the effects of high-dose corticosteroid therapy. Therefore, it is understandable that there are no reports of inducing OP with JAK inhibitors and that tofacitinib was highly effective for OP in our cases.