Answer
Aug 19, 2026 - 02:17 PM
Long-term treatment with Xeljanz (tofacitinib) can be effective, but it carries several important risks. These are potential risks rather than effects that everyone will experience.
The most important long-term concerns are:
- Serious infections:Xeljanz suppresses parts of the immune system, increasing susceptibility to infections including tuberculosis, shingles, bacterial infections, and opportunistic fungal infections. Some infections can require hospitalization.
- Heart attack and stroke: The FDA found a higher rate of major cardiovascular events with Xeljanz than with TNF-blocker medications in a safety study involving rheumatoid arthritis patients age 50 or older who had at least one cardiovascular risk factor. Current or former smokers had additional risk.
- Blood clots: Deep-vein thrombosis (DVT), pulmonary embolism (PE), and arterial blood clots can occur. The risk is particularly important in people who already have risk factors for thrombosis.
- Certain cancers: Lymphoma, lung cancer, and other malignancies have been reported. In the FDA safety study, cancers occurred more frequently with Xeljanz than with TNF blockers; current or former smokers were at additional risk. Non-melanoma skin cancers have also occurred.
- Changes in blood counts: Long-term treatment can lower lymphocytes, neutrophils, or hemoglobin. The FDA recommends periodic blood testing, generally including monitoring every three months after initial testing.
- Higher cholesterol:Xeljanz can raise total cholesterol, LDL and HDL, with changes generally appearing within the first several weeks. Lipids should therefore be monitored.
- Liver enzyme elevations: Liver tests may rise during treatment, so routine liver-function monitoring is recommended.
- Rare gastrointestinal perforation: A hole in the stomach or intestine has been reported, with particular concern in people with conditions such as diverticulitis or those taking certain medications such as NSAIDs.
The FDA's current prescribing information carries a boxed warning for serious infections, mortality, cancer, major cardiovascular events, and thrombosis.
That doesn't mean Xeljanz is unsafe for everyone. Your age, smoking history, previous blood clots, cardiovascular disease, cancer history, dose, and other medications significantly affect the benefit-risk calculation. Regular blood tests and follow-up are an important part of long-term treatment. Don't stop Xeljanz abruptly without discussing it with the prescriber.
