A Few Good Meds #3: TOFACITINIB
It's the NEW STEROID:
1) broadly targeting most pro-inflammatory cytokines (except TNF & IL1);
2) short-acting (fast washout in the event of side-effects);
3) fast-acting (under a week, great for therapeutic trial);
4) comes as a pill (easy storage, patient in control).
BUT without the metabolic/endocrine side-effects (almost) of steroids like weight gain, muscle weakness, bone loss, hypertension, dyslipidaemia, diabetes, insomnia, psychosis...
What's not to like about TOFACITINIB? The PRICE $$$
This paper gives a good overview of the efficacy and safety of Tofacitinib in RA, as demonstrated in the ORAL trials.
It works in RA where others (csDMARDs and biologics) have failed, as Standalone, and even as First Line! Does this not take the guesswork out of RA treatment😉
After RA, Tofacitinib is now filing for registration for Psoriasis.
As further proof that Tofacitinib is the New (Designer) Steroid, it is being trialed in a whole host of diversely-mediated immune diseases. Although it has been canned in Ankylosing Spondylitis, Asthma, Crohn's Disease, Dry eyes, Irritable Bowel Syndrome and Renal transplant rejection, it is looking good in Phase 3 for Psoriatic Arthritis, Juvenile RA and Ulcerative Colitis, and Phase 2 for Atopic Dermatitis.
Even without FDA marketing approval or Pfizer sanctioned clinical trials, Tofacitinib is being tried off-label by all and sundry for anything vaguely autoimmune; like steroids😰. Use will spike especially for pain and aesthetic "indications" if proven efficacious; like steroids😲. Abuse is foretold when it becomes easily available; like steroids and opioids😱.