Xeljanz (Tofacitinib citrate)

QUESTION 1

Xeljanz (Tofacitinib citrate)

QUESTION 1

Xeljanz inhibits the _______ of JAK enzymes to prevent exacerbation of the inflammatory cascade.

A) Sulfation

B) Hydroxylation

C) Autophosphorylation

D) Dimerization

Xeljanz inhibits the _______ of JAK enzymes to prevent exacerbation of the inflammatory cascade.

A) Sulfation

B) Hydroxylation

D) Dimerization

C) Autophosphorylation

QUESTION 2

What lab value must be drawn prior to starting and during therapy of Xeljanz?

A) Absolute neutrophil count

B) Red blood cell count

C) Liver enzymes

D) Platelets

QUESTION 2

A) Absolute neutrophil count

What lab value must be drawn prior to starting and during therapy of Xeljanz?

B) Red blood cell count

C) Liver enzymes

D) Platelets

Insurance Coverage

Clinical Trials Summary

Xeljanz may be covered under some insurances.

Manufacture offers:

• Hardship Assistance for those without insurance.
• Co-Pay savings card to those with private insurance that do not cover it.

Pricing

METHODS: Methotrexate naive patients with active RA were given Xeljanz monotherapy or Methotrexate monotherapy for 24 months.

Results: Xeljanz was shown to be associated with inhibition of the progression of the disease and lead to improvements in physical functioning.

No differences noted in the safety profiles.

Xeljanz 5mg (immediate release): WAC price for quantity of 60 is $3,468.36

AWP for quantity of 60 is $4,162.03

Xeljanz 11mg (extended release): WAC price for quantity of 30 is $3,468.36

AWP for quantity of 30 is $4,162.03

Indications

Xeljanz is used to treat Rheumatoid arthritis in patients with inadequate response or intolerance to Methotrexate.

By: Brandy Rodenberg

Possible Deformities:

Adverse Reactions

Common:

• Increased HDL/LDL
• Headache
• UTI
• Nasopharygitis
• Upper Respiratory Infection

Serious:

• Skin cancer
• DECREASED LYMPHOCYTE COUNT
• NEUTROPENIA
• Injury to liver
• Infectious disease/opportunistic infection

Do NOT Initiate

What is Rheumatoid Arthritis (RA)?

RESOURCES

Patient's with a/an:

• Absolute neutrophil count less than 1000 cells/mm(3)
• Lymphocyte cell less than 500 cells/mm(3)
• Hemoglobin level less than 9 g/dL

Always do prior to initiating Xeljanz:

• Test for latent or active TB
• Screen for viral hepatitis
• Update immunizations

Rheumatoid arthritis is a chronic autoimmune disorder that normally targets the smaller joints of the body, but can damage a variety of body systems. Inflammation is the major factor that causes the damage to the cartilage and bones.

Symptoms:

• Fleischmann RM, Huizinga TW, Kavanaugh AF, Wilkinson B, Kwok K, DeMasi R, van Vollenhoven RF. Efficacy of tofacitinib monotherapy in methotrexate-naive patients with early or established rheumatoid arthritis. RMD Open. 2016 Jul 26
• "XELJANZ Financial Help." Financial Help. Pfizer, 2016. Web. 09 Aug. 2016.
• "Latent Tuberculosis Infection in RA: The Disease and the Diagnosis." Rheumatology Network. UBM Company, 27 June 2011. Web. 09 Aug. 2016.
• Micromedex® Healthcare Series [Internet database]. Greenwood Village, Colo: Thomson Micromedex. Updated periodically. Accessed August 8, 2016.
• Red Book Online [database online]. Greenwood Village, CO: Truven Health Analytics. http://www.micromedexsolutions.com/. Updated 2016. Accessed August 8, 2016.
• Ruderman, Eric, and Siddharth Tambar. "Rheumatoid Arthritis." Diseases and Conditions. American College of Rheumatology, Aug. 2013. Web. 08 Aug. 2016.
• Xeljanz [package insert]. New York, NY: Pfizer Inc; 2016

pain, long lasting morning stiffness, limited motion, rheumatoid nodules, swan neck deformities, ulnar deviation

Mechanism of Action

Target:

Janus Kinases (JAK)

How it works:

Xeljanz

Manufacturer:

Pfizer

Inhibits autophosphorylization of JAK enzymes, which normally results in a downstream phosphorylization of the cytokine receptor. But, since the JAK enzyme never becomes phosphorylated this is unable to occur. This prevents the STAT from becoming activated and eventually dissociating from the cytokine receptor to regulate DNA transcription in the nucleus.

Phase of studies:

Phase IV for indication of rheumatoid arthritis

There is currently no generic for this medication

Administration/Dosing

Tablet

Formulation:

Immediate Release:

5 mg BID as monotherapy or in combo with

non-biological DMAR (ex. Methotrexate)

Extended Release:

11 mg once daily as monotherapy or in combo with non-biological DMARD