Medical Information

Tofacitinib, as a JAK inhibitor, is mainly used for the treatment of autoimmune diseases such as rheumatoid arthritis, with significant therapeutic effects, but attention should be paid to proper discontinuation procedures. The following will explain from two aspects: evaluation of treatment efficacy and precautions for discontinuation of medication.

1. Evaluation of treatment efficacy

(1) Rheumatoid arthritis

Clinical studies have shown that tofacitinib alone or in combination with methotrexate can significantly improve joint swelling/tenderness symptoms, with an ACR50 response rate of approximately 40% -60%. The onset time is usually 2-4 weeks, and continuous medication can delay imaging progression.

(2) Psoriatic arthritis

It can effectively alleviate skin lesions and joint symptoms, and about 50% of patients meet the ACR20 improvement standard. It may still be effective for patients with poor efficacy of traditional DMARDs.

(3) Ulcerative colitis

After 8 weeks of induction therapy, the clinical remission rate of patients with moderate to severe activity can reach 30% -40%. Maintenance therapy can reduce the risk of recurrence and is as effective as biologics.

2 Precautions for discontinuation of medication

(1) The principle of gradual reduction

Sudden discontinuation of medication may lead to a resurgence of the disease. It is recommended to gradually reduce the dosage under the guidance of a doctor, such as changing from twice a day to once a day, and maintain it for 2-4 weeks before stopping.

(2) Indications for discontinuation of medication

When serious infections, thrombotic events, or malignant tumors occur, medication should be stopped immediately. Continuous abnormal liver function (ALT>3x upper limit) or severe reduction of blood cells also require termination of treatment.

(3) Monitoring after discontinuation of medication

Regular follow-up for 3-6 months is still necessary after discontinuation of medication to monitor disease activity and potential delayed side effects (such as infection and changes in blood lipids). Recurrent patients need to reassess their treatment plan.

(4) Handling of special populations

Elderly or patients with liver and kidney insufficiency need to extend the monitoring period after discontinuing medication. Pregnancy planners should confirm drug clearance at least 4 weeks after discontinuing medication before considering conception.