What happens when you stop taking Xeljanz?
Xeljanz (tofacitinib citrate) is a Janus kinase (JAK) inhibitor used for rheumatoid arthritis, psoriasis arthritis, ulcerative colitis, polyarticular course juvenile idiopathic arthritis and ankylosing spondylitis. You should not stop taking Xeljanz without consulting your doctor.
Stopping treatment with Xeljanz may cause the symptoms of your condition to return. However, some patients are able to stop Xeljanz without their symptoms flaring up, according to the results of research conducted in patients with rheumatoid arthritis.
A total of 20 of the 54 patients who discontinued Xeljanz did not have a flare-up of their symptoms in the year after stopping the drug, according to the results of one study. The study was conducted in patients with rheumatoid arthritis who had achieved low disease activity while on Xeljanz.
In a separate study researchers found that patients with rheumatoid arthritis were less likely to have a flare-up of their symptoms if their dose of Xeljanz was gradually reduced compared with immediate withdrawal of the drug. Approximately half of the patients who gradually reduced their dose of Xeljanz did not have a flare-up of their symptoms in the 21 months after stopping the drug, compared with only 7 months following immediate withdrawal of Xeljanz. Restarting Xeljanz typically enabled symptoms to be brought under control quickly in patients whose symptoms had returned.
In addition to stopping Xeljanz because of low disease activity, there are other reasons Xeljanz may need to be stopped.
Why might I need to stop taking Xeljanz?
Treatment with Xeljanz may need to be stopped for a number of reasons, for example:
Blood clots. Xeljanz can cause blood clots in the lungs (pulmonary embolism), veins of the legs (deep vein thrombosis) and arteries (arterial thrombosis). If you develop the following symptoms of a blood clot you should stop taking Xeljanz and contact your doctor right away:
- Sudden shortness of breath or difficulty breathing
- Chest pain
- Swelling of the leg or arm
- Leg tenderness or pain
- Redness or discoloration in a leg or arm
Allergic reactions (hypersensitivity). Xeljanz can cause allergic reactions. If you develop the following symptoms of an allergic reaction you should stop taking Xeljanz and contact your doctor right away:
- Swelling of your lips, tongue or throat
- Raised, red patches of skin that are often itchy (hives)
Changes in blood test results. Your doctor may temporarily stop Xeljanz if your red blood cell count is too low (anemia), your infection-fighting white blood cells (lymptomcytes, neutrophils) are too low, or your liver tests are too high.
Surgery. It is recommended to stop Xeljanz at least seven days prior to surgery because the drug is known to increase the risk of serious infection even in patients not undergoing surgery.
- Food and Drug Administration (FDA). Xeljanz. September 2020, [Accessed December 24, 2021]. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/203214s028,208246s013,213082s003lbl.pdf.
- Goodman SM, Springer B, Guyatt G, et al. 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty. Arthritis Rheumatol. 2017;69(8):1538-1551. doi:10.1002/art.40149.
- Kubo S, Yamaoka K, Amano K, et al. Discontinuation of tofacitinib after achieving low disease activity in patients with rheumatoid arthritis: a multicentre, observational study. Rheumatology (Oxford). 2017;56(8):1293-1301. doi:10.1093/rheumatology/kex068.
- Mori S, Ueki Y. Outcomes of dose reduction, withdrawal, and restart of tofacitinib in patients with rheumatoid arthritis: a prospective observational study. Clin Rheumatol. 2019;38(12):3391-3400. doi:10.1007/s10067-019-04721-z.
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- Xeljanz Information for Consumers
- Xeljanz Information for Healthcare Professionals (includes dosage details)
- Side Effects of Xeljanz (detailed)