Dr. Ahmed “Is Tofacitinib a Steroid? I’ve been taking prednisolone tablets along with Methotrexate and Hydroxychloroquine for three months, and my doctor just gave me Tofacitinib for joint pain and stiffness.
I’m not sure why I need both. Is Tofacitinib a steroid, or does it work differently?”
A 45-year-old female patient undergoing treatment for Rheumatoid Arthritis (RA) asked this question.
The answer is clear and straightforward: No! Tofacitinib (Xeljanz) is not a steroid, so there’s no need to be concerned about taking two steroid pills.
I decided to write in more detail about Tofacitinib and how it is different from steroids. Here we go:
What is Tofacitnib?
Tofacitinib is an orally available biological DMARD, under the brand name, Xeljanz. It has been marketed by Pfizer Pharmaceuticals.
Generic brands have been available since 2021 which are much cheaper.
Tofacitinib is a novel class of medicine called the JAK inhibitors (Janus kinase). It preferentially blocks the JAK-1 and JAK-3 enzymes and exerts potent immune-modulatory effects.
Tofacitinib has been approved for the treatment of the following medical conditions [Ref]:
- Rheumatoid Arthritis as monotherapy or with methotrexate in patients who have moderate or severely active Rheumatoid arthritis.
- Psoriatic Arthritis, in patients with a poor response to methotrexate or other biological DMARD.
- Ankylosing Spondylitis
- Juvenile Idiopathic Arthritis, and
- Moderate to severely active Ulcerative Colitis.
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Tofacitinib Vs Steroids: Key Differences
Tofacitinib is a Janus Kinase Inhibitor. It exerts targeted effects on immune dysregulation in patients with Rheumatoid Arthritis and JIA, Psoriatic Arthritis, Ankylosing Spondylitis, and Ulcerative Colitis.
Unlike Tofacitinib, steroids are non-specific immune suppressants and anti-inflammatory drugs. Steroids come in different forms and are the most commonly used drugs worldwide.
They are indicated for more than 100 medical conditions ranging from autoimmune conditions such as RA and SLE to Allergic conditions like Asthma and Skin conditions such as eczema and vitiligo.
Onset of action of Tofacitinib vs. steroids:
Tofacitinib has a slow onset of action and may take 2 to 6 weeks for the full clinical response. Steroids, on the other hand, have a rapid onset of action and may take minutes to hours depending on the route of administration and the underlying condition.
Injectable and inhalational steroids may take minutes while oral steroids may take hours to days.
Duration of action of Tofacitinib vs. steroids:
Tofacitinib is a safe drug when used for a prolonged duration and does not have long-term serious side effects such as diabetes, hypertension, or osteoporosis.
Long-term steroid use may result in Cushing’s syndrome. Patients on long-term steroids may also develop complications like diabetes, hypertension, and osteoporosis which may persist throughout the patient’s life.
Use in Emergencies:
Because steroids have a rapid onset of action, they may be used in emergencies like acute severe asthma, angioedema, acute flare of gouty, or Rheumatoid arthritis.
Tofacitinib is not indicated in acute flares or emergency medical conditions. They may be used in conjunction with steroids but not alone.
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Is Tofacitinib as Effective as Steroids?
The effectiveness of Tofacitinib and steroids depends on what illness you’re treating. It doesn’t make sense to compare these two medicines for conditions they aren’t officially used to treat.
Tofacitinib is approved by the FDA (U.S. Food and Drug Administration) for five specific conditions:
- Rheumatoid Arthritis
- Psoriatic Arthritis
- Juvenile Idiopathic Arthritis
- Ankylosing Spondylitis
- Ulcerative Colitis
Steroids are now seen as a temporary solution to manage symptoms or buy some time.
People may continue taking steroids until their symptoms get better with Tofacitinib treatment.
In a study, adding Tofacitinib allowed about 30% of patients with long-standing Rheumatoid Arthritis to stop taking prednisolone (a type of steroid) [Ref].
For the rapid relief of severe active Arthritis or Ulcerative Colitis, oral or parenteral steroids are usually administered.
Steroids are especially helpful in critical situations, like when someone has a severe flare-up of ulcerative colitis or rheumatoid arthritis with complications involving the kidneys, brain, or lungs. These situations can be life-threatening.
Although steroids are preferred for inducing remission in patients with active ulcerative colitis, in one study, tofacitinib was equally effective [Ref]
However, for patients with Psoriatic arthritis, systemic steroids are generally avoided because they might worsen skin psoriasis symptoms.
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When to use Tofacitinib and Steroids Together?
Steroids are inexpensive, easy to find, and potent anti-inflammatory drugs with some immune-modulating effects.
But, because steroids have many side effects, they are usually used for sudden flare-ups and emergencies.
Also, at the beginning, Tofacitinib and steroids are given together. Once Tofacitinib starts working, which takes a few weeks, steroids are then gradually tapered off.
Because Tofacitinib (Xeljanz) is a strong biological medicine, even people with severe and long-lasting illnesses can often stop taking steroids completely or may require them in very small amounts.
However, some patients still need a little bit of steroids to prevent adrenal insufficiency and keep the anti-inflammatory, appetite-boosting, and mood-lifting effects of steroids.
It’s important to mention that when you use Tofacitinib and Steroids together, there’s a higher chance of experiencing serious side effects.
The risk of getting opportunistic infections is much higher when both drugs are used at the same time, compared to using each medicine separately [Ref]
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Why Prefer Tofacitinib Over Steroids?
Tofacitinib is a more powerful medicine than steroids. Steroids might help reduce your pain for a little while, but you’ll need more of them over time.
Also, steroids don’t stop the disease from getting worse. So, eventually, your joints can get damaged, making it hard to move around.
Tofacitinib (Xeljanz) works differently. It goes after the immune cells that harm your joints.
When you use Tofacitinib for a long time, it not only eases your pain but also stops your joints from getting damaged and helps you move better.
On the other hand, using steroids for a long time can lead to serious problems like diabetes, high blood pressure, weak bones, fungal and bacterial infections, and weaker muscles.
Except for the risk of opportunistic infections, using Tofacitinib for a long time doesn’t have most of these problems.
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When NOT to Use Tofacitinib?
Don’t use steroids for conditions they aren’t approved to treat unless it’s for research and you have the right permissions.
Avoid using Tofacitinib in these cases:
- When your blood doesn’t have enough cells due to bone marrow problems.
- If you have heart issues like heart failure, heart rhythm problems, or a long QT interval.
- When you have an active infection.
- If you’re allergic to it.
Be careful if you have liver or kidney problems. Also, there’s a higher chance of getting certain cancers, so doctors will keep a close eye on you for any strange symptoms.
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In Conclusion:
Tofacitinib and steroids are not the same, and it’s important to understand the differences between them.
Tofacitinib is a potent medication used to treat specific conditions like Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis, Juvenile Idiopathic Arthritis, and Ulcerative Colitis.
It targets key immune cells responsible for joint damage and can be effective in the long term without some of the serious side effects associated with steroids.
Steroids, on the other hand, are more commonly used for a wide range of medical conditions but are generally reserved for acute flares and emergencies due to their rapid onset of action.
Prolonged steroid use can lead to significant side effects, including diabetes, high blood pressure, and weakened bones and muscles.
Combining Tofacitinib and steroids should be done with caution, as it can increase the risk of adverse events, especially opportunistic infections. It’s crucial to follow your doctor’s guidance on when and how to use these medications.
Ultimately, the choice between Tofacitinib and steroids depends on the specific medical condition, its severity, and the individual patient’s needs.
Always consult with your healthcare provider to determine the most suitable treatment plan for your condition.
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