Scroll for Important Safety Information and Indication

INDICATION

  • XELJANZ/XELJANZ XR (tofacitinib) is indicated for the treatment of adult patients with moderately to severely active rheumatoid arthritis who have had an inadequate response or intolerance to methotrexate. It may be used as monotherapy or in combination with methotrexate or other nonbiologic disease-modifying antirheumatic drugs (DMARDs).
  • Limitations of Use: Use of XELJANZ/XELJANZ XR in combination with biologic DMARDs or with potent immunosuppressants such as azathioprine and cyclosporine is not recommended.

IMPORTANT SAFETY INFORMATION

WARNING: SERIOUS INFECTIONS AND MALIGNANCY

SERIOUS INFECTIONS

Patients treated with XELJANZ/XELJANZ XR are at increased risk for developing serious infections that may lead to hospitalization or death. Most patients who developed these infections were taking concomitant immunosuppressants, such as methotrexate or corticosteroids.

If a serious infection develops, interrupt XELJANZ/XELJANZ XR until the infection is controlled.

Reported infections include:

  • Active tuberculosis, which may present with pulmonary or extrapulmonary disease. Patients should be tested for latent tuberculosis before XELJANZ/XELJANZ XR use and during therapy. Treatment for latent infection should be initiated prior to XELJANZ/XELJANZ XR use.
  • Invasive fungal infections, including cryptococcosis and pneumocystosis. Patients with invasive fungal infections may present with disseminated, rather than localized, disease.
  • Bacterial, viral, and other infections due to opportunistic pathogens.

The risks and benefits of treatment with XELJANZ/XELJANZ XR should be carefully considered prior to initiating therapy in patients with chronic or recurrent infection.

Patients should be closely monitored for the development of signs and symptoms of infection during and after treatment with XELJANZ/XELJANZ XR, including the possible development of tuberculosis in patients who tested negative for latent tuberculosis infection prior to initiating therapy.

MALIGNANCIES
Lymphoma and other malignancies have been observed in patients treated with XELJANZ. Epstein Barr Virus—associated post-transplant lymphoproliferative disorder has been observed at an increased rate in renal transplant patients treated with XELJANZ and concomitant immunosuppressive medications.

SERIOUS INFECTIONS
The most common serious infections reported with XELJANZ included pneumonia, cellulitis, herpes zoster, urinary tract infection, and diverticulitis. Avoid use of XELJANZ/XELJANZ XR in patients with an active, serious infection, including localized infections. Consider the risks and benefits of treatment before initiating XELJANZ/XELJANZ XR in patients:

  • with chronic or recurrent infection;
  • who have been exposed to tuberculosis (TB);
  • with a history of a serious or an opportunistic infection;
  • who have lived or traveled in areas of endemic TB or mycoses; or
  • with underlying conditions that may predispose them to infection.

Patients should be closely monitored for the development of signs and symptoms of infection during and after treatment with XELJANZ/XELJANZ XR. XELJANZ/XELJANZ XR should be interrupted if a patient develops a serious infection, an opportunistic infection, or sepsis.

Tuberculosis
Evaluate and test patients for latent or active infection before administration of XELJANZ/XELJANZ XR. Consider anti-TB therapy prior to administration of XELJANZ/XELJANZ XR in patients with a past history of latent or active TB in whom an adequate course of treatment cannot be confirmed, and for patients with a negative test for latent TB but who have risk factors for TB infection. Treat patients with latent TB with standard therapy before administering XELJANZ/XELJANZ XR.

Viral Reactivation
Viral reactivation, including cases of herpes virus reactivation (eg, herpes zoster), was observed in clinical studies with XELJANZ. Screening for viral hepatitis should be performed in accordance with clinical guidelines before starting therapy with XELJANZ/XELJANZ XR. The risk of herpes zoster is increased in patients treated with XELJANZ/XELJANZ XR and appears to be higher in patients treated with XELJANZ in Japan.

MALIGNANCY and LYMPHOPROLIFERATIVE DISORDERS
Consider the risks and benefits of XELJANZ/XELJANZ XR treatment prior to initiating therapy in patients with a known malignancy other than a successfully treated non-melanoma skin cancer (NMSC) or when considering continuing XELJANZ/XELJANZ XR in patients who develop a malignancy.

In the 7 controlled rheumatoid arthritis clinical studies, 11 solid cancers and 1 lymphoma were diagnosed in 3328 patients receiving XELJANZ with or without DMARD, compared to 0 solid cancers and 0 lymphomas in 809 patients in the placebo with or without DMARD group during the first 12 months of exposure. Lymphomas and solid cancers have also been observed in the long-term extension studies in rheumatoid arthritis patients treated with XELJANZ.

In Phase 2B controlled dose-ranging trials in de-novo renal transplant patients, all of whom received induction therapy with basiliximab, high-dose corticosteroids, and mycophenolic acid products, Epstein Barr Virus—associated post-transplant lymphoproliferative disorder was observed in 5 out of 218 patients treated with XELJANZ (2.3%) compared to 0 out of 111 patients treated with cyclosporine.

Non-Melanoma Skin Cancer
Non-melanoma skin cancers (NMSCs) have been reported in patients treated with XELJANZ. Periodic skin examination is recommended for patients who are at increased risk for skin cancer.

GASTROINTESTINAL PERFORATIONS
Gastrointestinal perforations have been reported in XELJANZ rheumatoid arthritis clinical trials, although the role of JAK inhibition is not known. This happens most often in people who also take nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or methotrexate. XELJANZ/XELJANZ XR should be used with caution in patients who may be at increased risk for gastrointestinal perforation (eg, patients with a history of diverticulitis).

LABORATORY ABNORMALITIES
Lymphocyte Abnormalities
Treatment with XELJANZ was associated with initial lymphocytosis at 1 month of exposure followed by a gradual decrease in mean lymphocyte counts of approximately 10% during 12 months of therapy. Counts less than 500 cells/mm3 were associated with an increased incidence of treated and serious infections. Avoid initiation of XELJANZ/XELJANZ XR treatment in patients with a count less than 500 cells/mm3. In patients who develop a confirmed absolute lymphocyte count less than 500 cells/mm3, treatment with XELJANZ/XELJANZ XR is not recommended. Monitor lymphocyte counts at baseline and every 3 months thereafter.

Neutropenia
Treatment with XELJANZ was associated with an increased incidence of neutropenia (less than 2000 cells/mm3) compared to placebo. Avoid initiation of XELJANZ/XELJANZ XR treatment in patients with an ANC less than 1000 cells/mm3. For patients who develop a persistent ANC of 500-1000 cells/mm3, interrupt XELJANZ/XELJANZ XR dosing until ANC is greater than or equal to 1000 cells/mm3. In patients who develop an ANC less than 500 cells/mm3, treatment with XELJANZ/XELJANZ XR is not recommended. Monitor neutrophil counts at baseline and after 4-8 weeks of treatment and every 3 months thereafter.

Anemia
Avoid initiation of XELJANZ/XELJANZ XR treatment in patients with a hemoglobin level less than 9 g/dL. Treatment with XELJANZ/XELJANZ XR should be interrupted in patients who develop hemoglobin levels less than 8 g/dL or whose hemoglobin level drops greater than 2 g/dL on treatment. Monitor hemoglobin at baseline and after 4-8 weeks of treatment and every 3 months thereafter.

Liver Enzyme Elevations
Treatment with XELJANZ was associated with an increased incidence of liver enzyme elevation compared to placebo. Most of these abnormalities occurred in studies with background DMARD (primarily methotrexate) therapy.

Routine monitoring of liver tests and prompt investigation of the causes of liver enzyme elevations is recommended to identify potential cases of drug-induced liver injury. If drug-induced liver injury is suspected, the administration of XELJANZ/XELJANZ XR should be interrupted until this diagnosis has been excluded.

Lipid Elevations
Treatment with XELJANZ was associated with increases in lipid parameters, including total cholesterol, low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein (HDL) cholesterol. Maximum effects were generally observed within 6 weeks.

Assess lipid parameters approximately 4-8 weeks following initiation of XELJANZ/XELJANZ XR therapy, and manage patients according to clinical guidelines for the management of hyperlipidemia.

VACCINATIONS
Avoid use of live vaccines concurrently with XELJANZ/XELJANZ XR. Update immunizations in agreement with current immunization guidelines prior to initiating XELJANZ/XELJANZ XR therapy.

GENERAL
Specific to XELJANZ XR
Caution should be used when administering XELJANZ XR to patients with pre-existing severe gastrointestinal narrowing. There have been rare reports of obstructive symptoms in patients with known strictures in association with the ingestion of other drugs utilizing a non-deformable extended release formulation.

HEPATIC and RENAL IMPAIRMENT
Use of XELJANZ/XELJANZ XR in patients with severe hepatic impairment is not recommended.

The recommended dose in patients with moderate hepatic impairment or with moderate or severe renal impairment is XELJANZ 5 mg once daily.

ADVERSE REACTIONS
The most common serious adverse reactions were serious infections. The most commonly reported adverse reactions during the first 3 months in controlled clinical trials with XELJANZ 5 mg twice daily and placebo, respectively, (occurring in greater than or equal to 2% of patients treated with XELJANZ with or without DMARDs) were upper respiratory tract infections (4.5%, 3.3%), headache (4.3%, 2.1%), diarrhea (4.0%, 2.3%), and nasopharyngitis (3.8%, 2.8%).

USE IN PREGNANCY
There are no adequate and well-controlled studies in pregnant women. XELJANZ/XELJANZ XR should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Please see full Prescribing Information including BOXED WARNING and Medication Guide.

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When MTX isn’t right, could XELJANZ or XELJANZ XR be right for her?1,a,b

Learn more about clinical data that may help you to determine if XELJANZ (tofacitinib citrate) 5 mg tablets is appropriate for your patients. Scroll down to also find information about resources that could help your patients successfully start therapy.

aXELJANZ XR 11 mg administered once daily is pharmacokinetically equivalent to XELJANZ 5 mg administered twice daily.1

bRecommended dose in patients with moderate and severe renal impairment and moderate hepatic impairment is XELJANZ 5 mg once daily.1

Powerful efficacy, with or without MTX, across a broad range of RA patient types1-8

Significant reductions of RA signs and symptoms demonstrated across 6 phase 3 studies.1-8
Studies were conducted with XELJANZ 5 mg BID dosing.1

Graph
i XELJANZ/XELJANZ XR is not indicated in MTX-naïve patients.1

ACR20 was a coprimary endpoint in Sync, Standard, Scan, Solo, and Step, and ACR70 was a coprimary endpoint in Start.1

ACR20/50/70 results at month 6 for placebo + nonbiologic DMARDs were 31%, 13%, 3% (Sync), placebo + MTX were 28%, 12%, 2% (Standard), and 25%, 9%, 1% (Scan).1,8

ACR20/50/70 results at month 6 for MTX were 51%, 27%, 12% (Start).8

ACR20/50/70 results at month 3 for placebo were 26%, 12%, 6% (Solo), and placebo + MTX were 24%, 8%, 2% (Step).1

See study designs.


Get the facts on XELJANZ

Powerful efficacy1,2,7
XELJANZ demonstrated statistically significantly superior ACR70 response rates vs MTX7,8
Graph

XELJANZ/XELJANZ XR is not indicated in MTX-naïve patients.1

XELJANZ is the only RA agent to use the ACR70 response rate as a coprimary efficacy endpoint7,j

  • In ORAL Start, ACR20/50 response rates for XELJANZ 5 mg at month 6, year 1, and year 2 were 71%k/47%k, 68%l/50%m, and 64%k/49%k vs MTX 51%/27%, 51%/34%, and 42%/28%, respectively7,8
  • More patients overall discontinued MTX vs XELJANZ as monotherapy8,n

ACR70 was a coprimary endpoint at month 6 and a secondary endpoint thereafter.1,8

jNonresponder imputation (NRI); kP<0.0001 vs MTX; lP=0.0001 vs MTX; mP=0.0002 vs MTX.8
n43.0% (80/186) of patients discontinued treatment in the MTX group compared with 28.7% (107/373) of patients in the XELJANZ 5 mg BID group. 8

See study design.



XELJANZ delivered powerful efficacy even without MTX1,2,8
Graph

ACR20 was a coprimary endpoint at month 3 and a secondary endpoint at week 2 and month 6.1,8
Data for placebo treatment are not available beyond month 3 due to placebo advancement.1

In ORAL Solo:

  • 209 out of 243 patients received prior MTX in the XELJANZ 5 mg group8
  • 102 out of 122 patients received prior MTX in the placebo group8

See study design.

Reduces progression of structural damage1,8
XELJANZ provided greater inhibition of structural damage progression vs MTX at month 6 and was sustained out to year 2 as a single agent1,7,8

Studies were conducted with XELJANZ 5 mg BID dosing.1



Graph

XELJANZ/XELJANZ XR is not indicated for MTX-naive patients.1

In ORAL Start at year 2, change in mTSS from baseline for XELJANZ 5 mg (0.6) vs MTX (2.1) (P=0.0002).7,8

See study design.



XELJANZ reduced the progression of structural damage as combination therapy1,5,8

Studies were conducted with XELJANZ 5 mg BID dosing.1



Graph

XELJANZ/XELJANZ XR is not indicated for MTX-naive patients.1

XELJANZ 5 mg twice daily + MTX reduced mean progression of structural damage vs placebo + MTX at month 6 (not statistically significant).1,5,8

See study design.

Improvements in physical function2,7,8
XELJANZ, as a single agent, provided patients with significant improvements in physical function2,7,8

Studies were conducted with XELJANZ 5 mg tablets BID dosing.1
In 2 separate studies, XELJANZ monotherapy treatment resulted in significant improvements in HAQ-DI scores.1,2,7,8

Graph

HAQ-DI was a coprimary endpoint at month 3 and a secondary endpoint at month 6.1,8


See study design.


Graph

XELJANZ/XELJANZ XR is not indicated in MTX-naïve patients.1

HAQ-DI was a secondary endpoint at month 6, year 1, and year 2. ACR70 and mean change from baseline in mTSS were coprimary endpoints at month 6.1,8

XELJANZ monotherapy demonstrated sustained improvement in physical function at month 6 and out to year 2.8

Mean MTX dose at end of titration (month 3)=18.5 mg/week.7


See study design.

2015 ACR Guideline
XELJANZ 5 mg BID is included in the 2015 ACR RA treatment guideline post MTX in established RA.9,v,w

vTofacitinib 5 mg BID, trade name XELJANZ, is included in the ACR guideline.1,9

wIn patients with moderate to high disease activity with ≥6 months duration of disease and post DMARD (MTX preferred).9


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XELJANZ + MTX OR ADALIMUMAB + MTX VS PLACEBO1,4

ORAL Standard was not designed to provide head-to-head comparative efficacy data and should not be interpreted as evidence of superiority or noninferiority to adalimumab. There are no head-to-head studies between XELJANZ and adalimumab or any other biologic DMARD.1,4

ORAL Standard Study Design
ORAL Standard at Month 6
ORAL Standard Safety

Study Description

A 12-month, randomized, double-blind, double-dummy, placebo-controlled, multicenter trial in which 717 patients with moderately to severely active RA who had an inadequate response to MTX (but not to a TNFi) received XELJANZ 5 mg BID or 10 mg BID, adalimumab 40 mg s.c. every other week, or placebo (all patients on stable background MTX, the only permitted background DMARD). Stable low dose oral glucocorticoids allowed. At 3 months, nonresponding placebo patients were advanced blindly to XELJANZ 5 mg or 10 mg BID. At 6 months, all remaining placebo patients were advanced similarly. The three co-primary endpoints were ACR20 response rate and rate of DAS28-4(ESR) <2.6 at month 6; and HAQ-DI change at month 3. Non-responder imputation was applied to missing sign/symptom data, plus an advancement penalty for 3-month non-responders. This study was not designed as a head-to-head comparison between XELJANZ and adalimumab.1,4


Study Design1,4,8


Primary Endpoints1

  • ACR20 response at month 6
  • Mean change from baseline in HAQ-DI at month 3
  • Rates of DAS28-4(ESR) <2.6 at month 6

All patients received combination therapy with MTX.1 The approved dose of XELJANZ is 5 mg twice daily.1



Study Objective

ORAL Standard was designed to evaluate XELJANZ 5 mg and 10 mg twice daily at the primary efficacy endpoints of ACR20 response (6 months), mean change from baseline in HAQ-DI (3 months), and rates of DAS28-4(ESR) <2.6 (6 months), and 1-year safety data in patients with an IR to stable weekly doses of MTX. The study included a separate arm with patients receiving biologic TNF inhibitor, adalimumab, 40 mg every other week subcutaneous injections.1,4

ORAL Standard was not designed to provide head-to-head comparative efficacy data and should not be interpreted as evidence of superiority or noninferiority to adalimumab.4

  • Both XELJANZ arms and adalimumab arm were compared with placebo + MTX. Adalimumab + MTX vs placebo + MTX was a secondary endpoint. One of the secondary objectives of the study was to examine the efficacy of the adalimumab and XELJANZ arms1,4,8


  • There are no head-to-head studies to assess superiority or noninferiority between XELJANZ and adalimumab or any other biologic DMARD1,4
  • This study was not designed as a head-to-head comparison between XELJANZ and adalimumab and is not sufficient to demonstrate noninferiority or superiority to adalimumab4

XELJANZ demonstrated powerful efficacy in MTX-IR patients compared with placebo + MTX1,4,8

Significant ACR responses with XELJANZ 5 mg BID + MTX were observed as early as month 1 (time of first visit) and sustained at 1 year (secondary endpoints)8

  • Year 1 results (NRI) for XELJANZ 5 mg BID + MTX—ACR20: 49% (97/196); ACR50: 37% (72/196); ACR70: 23% (45/196)8
  • Year 1 results (NRI) for adalimumab 40 mg q 2 wk + MTX—ACR20: 49% (98/199); ACR50: 34% (67/199); ACR70: 17% (33/199)8

Improvements in HAQ-DI scores for XELJANZ + MTX were observed at month 3 and sustained at 1 year1,4,8

Significant DAS28-4(ESR) <2.6 responses with XELJANZ + MTX were observed at 6 months and sustained at 1 year4,8

ACR20 was a primary endpoint at 6 months; ACR50 and ACR70 were secondary endpoints.1,8

yNRI (nonresponder imputation), with advancement penalty: if patient had any missing data or did not have a response to therapy by month 3, the treatment was considered to be a failure even if they had a response after month 3.4

Selected safety results out to 1 year4

Safety Results

In ORAL Standard, XELJANZ + MTX delivered clinically meaningful outcomes for MTX-IR patients.1,4

XELJANZ is indicated for adults with moderately to severely active rheumatoid arthritis who have had an inadequate response or intolerance to MTX.1
XELJANZ + MTX DEMONSTRATED SUPERIOR RESULTS COMPARED WITH PLACEBO + MTX4,8
  • In ORAL Standard, results in MTX-IR patients treated with XELJANZ 5 mg twice daily + MTX, were superior to placebo + MTX with ACR 20/50/70 response rates of 52%, 37%, and 20% vs 28%, 12%, and 2%, respectively, for placebo + MTX (P<0.0001)8
  • Patients treated with XELJANZ 5 mg twice daily + MTX had significant improvement from baseline in HAQ-DI of -0.55 at month 3 versus placebo + MTX, -0.24 (P<0.0001)4,8
THE SAFETY PROFILE OF XELJANZ HAS BEEN EXTENSIVELY STUDIED IN RA CLINICAL TRIALS8
  • XELJANZ has >21,000 patient-years of drug exposure in ~6,300 patients (all doses; as of January 2016) across phase 1, phase 2, phase 3, and 2 LTE studies, 1 of which is still ongoing8
  • Approximately 320 patients taking XELJANZ 5 mg twice daily have been treated for 72 months or more (324 of 1525 total enrollment; exposure ranges from 1 month to 105 months) in open-label LTE studies, 1 of which is still ongoing8
  • In the ongoing LTE study, the safety profile has been evaluated out to 8 years8
  • XELJANZ has a BOXED WARNING for serious infections and malignancies1
FIRST ORAL JAK INHIBITOR INDICATED FOR THE TREATMENT OF RA1
  • XELJANZ is taken orally twice daily1