How does the safety of tofacitinib (Xeljanz) compare to other drugs?

Tofacitinib: How does its safety compare to other immunosuppressants?

Tofacitinib now has evidence as being helpful in alopecia areata. Large scale studies have been performed in rheumatoid arthritis patients and a lot of the information we use to counsel our patients comes from the rheumatoid arthritis field. We've been using tofacitinb for 2 years but the drug is still relatively new for alopecia areata. The largest study to date is still under 100 patients. 

I was interested to read recently how tofacitinib compared to a group of drugs called the DMARDS (which stands for disease modifying anti rheumatic drugs). These include well known drugs like methotrexate, sulfasalazine, hydroxychloroquine, and leflunomide. Less frequently used medications include gold salts, azathioprine, and cyclosporine might still be considered part of this group.

Research recently conducted by Kavanaugh et al looked at at the risk of infections, heart disease and cancer in rheumatoid arthritis patient using tofacitinib compared to DMARDS. Since we also use many of these DMARD drugs in AA (methotrexate and sulfasalazine for example) it gives us some idea of their safety


In this study by Kavanaugh et al, the rate for serious infection was 3.69 for tofacitinib,   2.39 for csDMARDs. The rate for herpes zoster (shingles) was 1.43 for tofacitinib,  and 0.47 for csDMARDs. The rate for total cardiovascular disease was 1.69 for tofacitinib;  and 2.59 for csDMARDs. The rate for malignancy was 1.81 for tofacitinib,  1.81 for csDMARDs. The rate for gastrointestinal perforation was 0.13 for tofacitinib, 0.02 for bDMARDs and 0 for csDMARDs.

Overall, It seems that tofacintib may have a slightly higher risk of infection and gastrointestinal perforation than some of our conventional drugs but cancer risks are similar.




Kavanaugh AF, et al. Abstract #2595. Presented at: American College of Rheumatology Annual Meeting; Nov. 11-16, 2016; Washington.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887

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