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FDA has required warnings about increased risk of serious heart-related events, cancer, blood clots, and death for JAK inhibitors that treat certain chronic inflammatory conditions


Based on a completed U.S. Food and Drug Administration ( FDA ) review of a large randomized safety clinical trial, FDA has concluded there is an increased risk of serious heart-related events such as myocardial infarction or stroke, cancer, blood clots, and death with the arthritis and ulcerative colitis medicines Xeljanz and Xeljanz XR ( Tofacitinib ).

This trial has compared Xeljanz with another type of medicine used to treat arthritis called tumor necrosis factor ( TNF ) blockers in patients with rheumatoid arthritis.
The trial’s final results has also shown an increased risk of blood clots and death with the lower dose of Xeljanz.
A prior Drug Safety Communication ( DSC ) based upon earlier results from this trial, reported an increased risk of blood clots and death only seen at the higher dose.

FDA is requiring new and updated warnings for two other arthritis medicines in the same drug class as Xeljanz, called Janus kinase ( JAK ) inhibitors, Olumiant ( Baricitinib ) and Rinvoq ( Upadacitinib ).
Olumiant and Rinvoq have not been studied in trials similar to the large safety clinical trial with Xeljanz, so the risks have not been adequately evaluated.
However, since they share mechanisms of action with Xeljanz, FDA considers that these medicines may have similar risks as seen in the Xeljanz safety trial.

Two other JAK inhibitors, Jakafi ( Ruxolitinib ) and Inrebic ( Fedratinib ), are not indicated for the treatment of arthritis and other inflammatory conditions and so are not a part of the updates being required to the prescribing information for Xeljanz, Xeljanz XR, Olumiant, and Rinvoq.
Jakafi and Inrebic are used to treat blood disorders and require different updates to their prescribing information. ( Xagena )

Source: FDA, 2021

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