Pre-Treatment Screening and Monitoring

Tofacitinib modulates immune function by inhibiting specific cytokine pathways, which, while beneficial in controlling inflammation, also increases the risk of infections, malignancies, and cardiovascular complications. Therefore, comprehensive screening and ongoing monitoring are essential before and during treatment.

1. Infection and Cancer Screening

Due to its immunosuppressive action, Tofacitinib may impair the body's natural defenses, predisposing patients to opportunistic infections and malignancies. As a precaution, clinicians perform thorough evaluations to rule out latent infections and assess oncologic risk.

Infection Screening (Baseline):

Tuberculosis: Chest X-ray and Mantoux test (especially critical in high-prevalence regions like India)
Hepatitis B Surface Antigen (HBsAg)
Hepatitis C Virus (Anti-HCV)
HIV Screening

2. Cardiovascular Risk Assessment

The U.S. FDA has issued warnings about an increased risk of serious cardiovascular events, including heart attack, stroke, venous thromboembolism, and mortality, particularly in high-risk individuals.

Your healthcare provider will evaluate:

History of smoking
Past or present heart disease, stroke, or blood clots
Other cardiovascular risk factors

3. Gastrointestinal Screening

Tofacitinib should be used with caution in patients with a history of diverticulitis, as it has been associated with gastrointestinal perforation. Concomitant use of NSAIDs (painkillers) and oral corticosteroids further increases this risk and should generally be avoided.

4. Laboratory Monitoring

Regular blood investigations are necessary to detect adverse effects early and ensure continued safety during therapy.

Baseline and Ongoing Tests (Typically Monthly):

Complete Blood Count (CBC)
Kidney Function Tests (KFT)
Liver Function Tests (LFT)
Lipid Profile

Precautions While Taking Tofacitinib

Patients on Tofacitinib should adhere to the following safety measures to minimize risks:

Avoid contact with individuals who have active infections
Do not take live vaccines during treatment
Consult your doctor before starting any new medication or herbal supplements
Practice strict personal hygiene to reduce infection risk
Do not miss scheduled follow-up visits and laboratory tests
Report any unusual symptoms immediately, including:
- Fever
- Chest or abdominal pain
- Unexplained bleeding or bruising
- Skin rashes or nodules
- Joint pains
- Appearance of new lumps