Retrospective investigation of the effect of tofacitinib on efficiency, side effect and full blood counting, lipid profile and liver function tests in patients with romatoid arthritis

Aim: Rheumatoid arthritis (RA) is an autoimmune, chronic and systemic disease that affects many organs. Cartilage and joint damage caused by synovial inflammation is the basis of the disease. The incidence of RA increases with age and female gender, with a prevalence of approximately 1-2%. As the pathogenesis of RA, which is influenced by many factors in its etiology, is further elucidated each passing day, new agents are added to the treatment. Tofacitinib, a novel drug, is a Janus tyrosine kinase inhibitor and it has taken place in the treatment of RA. The aim of this study was to determine the efficacy of Tofacitinib and its effects on laboratory parameters of RA patients and to show the possible side effects of Tofacitinib. Materials and Methods: In this study, total of 66 patients older than 18 years of age who were diagnosed with rheumatoid arthritis according to 2010 American College of Rheumatology (ACR) classification criteria and followed at the Yildirim Beyazit University Medical Faculty-Ankara City Hospital Rheumatology Outpatient Clinic and who were using Tofacitinib for at least three months were evaluated retrospectively with the support of the IT unit of the hospital. The rheumatology polyclinic epicrisis, re-evaluation notes, laboratory tests were examined through the hospital IT unit and data were collected through anamnesis and examination information obtained by interviewing the patients. Age, sex, year of RA diagnosis, age of RA diagnosis, presence of autoantibody at the time of diagnosis and co-morbidities were recorded. Complete blood count, lipid profile, liver transaminase levels, erythrocyte sedimentation rate and CRP levels were determined before tofacitinib treatment and at third and sixth month after the treatment. In addition, before and after tofasitinib treatment; the duration of morning stiffness time, DAS 28-ESR, VAS score were determined. The obtained data were uploaded to the SPSS database and analyzed statistically. Results: A total of 66 patients with rheumatoid arthritis according to the 2010 ACR classification criteria, who were taking Tofacitinib for at least three months, were included in our study. The mean age of the patients in our study was 54.7 ± 12.0 years and 84.8% were female. The mean duration of Tofacitinib use was 19.0 ± 13.5 months. While 19.7% of the patients received Tofacitinib as monotherapy, 80.3% received it in combination with at least a csDMARD. The duration of morning stiffness time , DAS-28 (ESR) and VAS (Patient) scores were significantly decreased after Tofacitinib treatment (p <0.001). The leukocyte count of the patients at the 6th month after treatment was significantly decreased compared to the pre-treatment (p=0.015), but hemoglobin level, platelet count, ESR, CRP, AST, ALT, total cholesterol, HDL, LDL and triglyceride values were not statistically significant (p> 0.05). Tofacitinib related side effects developed in 33.3% of the patients. The most common side effects were rash, cough, and nausea. Tofacitinib related Herpes zoster infection developed in 13.6% of the patients. In 48.5% of the patients, Tofacitinib was discontinued due to drug ineffectiveness, disease activation, and side effects. Conclusion: In the treatment guidelines for rheumatoid arthritis, targeted synthetic, biological or biosimilar agents are recommended in patients unresponsive to csDMARDs. The oral form of Tofacitinib provides easy of use compared to other drugs, but more extensive studies are needed on it's on effectiveness and safety.