The mechanism of action of tofacitinib - an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis

Clin Exp Rheumatol. Mar-Apr 2016;34(2):318-28. Epub 2016 Mar 10.

Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease characterised by infiltration of immune cells into the affected synovium, release of inflammatory cytokines and degradative mediators, and subsequent joint damage. Both innate and adaptive arms of the immune response play a role, with activation of immune cells leading to dysregulated expression of inflammatory cytokines. Cytokines work within a complex regulatory network in RA, signalling through different intracellular kinase pathways to modulate recruitment, activation and function of immune cells and other leukocytes. As our understanding of RA has advanced, intracellular signalling pathways such as Janus kinase (JAK) pathways have emerged as key hubs in the cytokine network and, therefore, important as therapeutic targets. Tofacitinib is an oral JAK inhibitor for the treatment of RA. Tofacitinib is a targeted small molecule, and an innovative advance in RA therapy, which modulates cytokines critical to the progression of immune and inflammatory responses. Herein we describe the mechanism of action of tofacitinib and the impact of JAK inhibition on the immune and inflammatory responses in RA.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Arthritis, Rheumatoid / drug therapy*
  • Arthritis, Rheumatoid / immunology
  • Cytokines / physiology
  • Humans
  • Janus Kinases / antagonists & inhibitors*
  • Janus Kinases / physiology
  • Lymphocyte Subsets / drug effects
  • Neutrophils / drug effects
  • Piperidines / pharmacology*
  • Piperidines / therapeutic use
  • Protein Kinase Inhibitors / pharmacology*
  • Pyrimidines / pharmacology*
  • Pyrimidines / therapeutic use
  • Pyrroles / pharmacology*
  • Pyrroles / therapeutic use
  • Signal Transduction / physiology

Substances

  • Cytokines
  • Piperidines
  • Protein Kinase Inhibitors
  • Pyrimidines
  • Pyrroles
  • tofacitinib
  • Janus Kinases