On 29 April, 2019, the Australian Federal Government announced that the medication tofacitinib (Xeljanx®) would be made available for those diagnosed with psoriatic arthritis from 1 May.

What is Psoriatic Arthritis?

Psoriatic arthritis is a form of autoimmune inflammatory arthritis. Autoimmune conditions occur when the immune system overreacts to a trigger, such as a wound or virus, and continues to attack healthy cells long after the initial trigger has gone. Genetics, lifestyle, the environment and other factors can affect the development of autoimmune conditions although the exact causes are not known.

Different autoimmune conditions affect different parts of the body, For example, the skin condition psoriasis involves inflammation and excessive reproduction of skin cells, while rheumatoid arthritis affects the lining of the joints. Psoriatic arthritis (PsA) and psoriasis often occur together, however, it is possible to have one condition and not the other. PsA most commonly affects the neck, spine, fingers or toes, although it can occur in other joints. It can also cause inflammation where tendons attach to joints (enthesitis).

What is Tofacitinib?

Tofacitinib (Xeljanx®) is a type of medication called a JAK inhibitor — a sub-classification of disease modifying antirheumatic drugs (DMARDs). This means it targets a specific part of the immune system (in this case, the JAK1 and JAK3 enzymes) and inhibits inflammatory activity.

Tofacitinib is not a biologic medication as it is produced synthetically and is taken orally. However, it is grouped with biologics for ease of processing through the Pharmaceutical Benefits Scheme (PBS) in Australia. Applications are processed using the same criteria as biologic medications for PsA. For example, patients must have demonstrated an inadequate response to methotrexate (Methoblastin®) and either sulfasalazine (Salazopyrin®) or leflunomide (Arava®) for at least 3 months prior to the PBS application.

Tofacitinib is prescribed as a 5 mg tablet taken twice daily (morning and evening).

What Does it Mean for Australians With PsA?

Tofacitinib is already available on prescription in Australia for rheumatoid arthritis and has provided relief for many people. The convenience of taking it in tablet form as opposed to biologic medications (which are infused or injected weekly, fortnightly or monthly) makes it an attractive treatment option.

As we each respond to medications differently, it is possible that some existing medical treatments don’t work (or don’t work sufficiently) for some people with psoriatic arthritis. Therefore, it is important that doctors and patients have the option to try as wide a range of treatments as possible.

Having tofacitinib available through the PBS means that patients only pay the subsidised cost of $40.30 per script (or $6.50 with an approved concession card) instead of the actual cost of $16,500 per year.

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Note: This information should never replace the information and advice from your treating doctors. It is meant to inform the discussion that you have with healthcare professionals, as well as others who play a role in your care and wellbeing.
CreakyJoints Australia encourages everyone with inflammatory arthritis to talk to a rheumatologist about finding the right treatment plan for you. These diseases can still cause underlying damage to your joints, bones and certain organs even if some symptoms improve. Conventional prescription medications are often at the core of treatment due to the strong evidence supporting their success.