Introduction

Tofacitinib (trade name: Xeljanz) has been approved in Germany since June 2018 for the systemic treatment of psoriatic arthritis in adults. It is an option for adults with active psoriatic arthritis who did not benefit enough from – or who did not tolerate – antirheumatic medication. Tofacitinib is used in combination with methotrexate.

Psoriatic arthritis is a condition that leads to pain and stiffness in joints. It can be caused by psoriasis, but sometimes occurs in people who don't have any visible psoriasis-related skin changes.

It is estimated that 20% of people who have psoriasis also develop pain and inflammation in their joints at some point. The joints start hurting and may feel stiff for a while, particularly in the morning.

Psoriatic arthritis can occur in many joints of the body. It often affects the hands, feet, elbows, knees, back of the neck or vertebrae (bones in the spine). More than five joints typically become inflamed, including the joints at the end of the fingers and toes. These joints are especially prone to becoming deformed in severe cases. Tendons and tendon sheaths can also become inflamed.

Treatment with tofacitinib aims to relieve reduce the inflammation of in the joints by inhibiting a protein, thereby reducing the production of several chemical messengers that promote inflammation.

Application

Tofacitinib is taken twice a day in tablet form. One tablet contains 5 mg of tofacitinib.

Other treatments

For patients with psoriatic arthritis who did not benefit enough from – or who cannot tolerate treatment with – disease-modifying antirheumatic medication, treatment with a tumor necrosis factor (TNF) α inhibitor is an option. This treatment can be combined with methotrexate.

For patients with psoriatic arthritis who did not benefit enough from – or who cannot tolerate – treatment with one particular disease-modifying biological disease-modifying antirheumatic drugs (bDMARD), treatment with a different disease-modifying biological antirheumatic drug (bDMARD) is an option. This treatment can be combined with methotrexate.

Assessment

In 2018, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) looked into whether tofacitinib for the treatment of psoriatic arthritis has any advantages or disadvantages compared with the standard treatments for the treatment of psoriatic arthritis for in adults who did not benefit from or who cannot tolerate treatment with antirheumatic medication.

But the manufacturer didn’t provide any suitable data with which to do the assessment.

More information

This information summarizes the main results of a review produced by the Institute for Quality and Efficiency in Health Care (IQWiG, Germany). The review was commissioned by the German Federal Joint Committee (G-BA) as part of the “early benefit assessment of medications.” On the basis of the review and the hearings received, the G-BA passed a resolution on the added benefit of tofacitinib (Xeljanz).