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Xeljanz Alternatives

Xeljanz lessens autoimmune damage to the body with conditions such as rheumatoid arthritis and psoriatic arthritis. Though it’s FDA-approved for these conditions and has worldwide use, its active ingredient, tofacitinib, can cause significant side effects, leaving patients looking for alternatives.

Last Modified: October 26, 2023
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What Types of Xeljanz Alternatives Are Available?

There are a number of Xeljanz alternatives available for patients with autoimmune conditions that target immune system overactivity. Doctors may also ask their patients to make specific dietary and exercise changes to ease symptoms.

Alternative Treatment Categories
  • Biologics: These medications are powerful immunosuppressants that doctors prescribe as first-line treatments for moderate to severe conditions.
  • Corticosteroids: These inflammation-soothing drugs come in pill form, as injections or as topical creams, in the case of psoriasis.
  • Diet: Some patients find it helpful to make general dietary changes such as limiting sugar, fried food, artificial ingredients or other specific foods that trigger their symptoms.
  • Immunosuppressants: This is a broad category of medication that includes biologics, corticosteroids and others that limit the activity of your immune system.
  • NSAIDS: Nonsteroidal anti-inflammatory drugs inhibit an enzyme called cyclooxygenase that increases inflammation in the body.
  • Occupational and physical therapy: OT teaches patients to better cope with their condition while working or performing daily tasks. PT provides targeted exercises that strengthen the body and improve flexibility.
  • Surgery: Often a last resort, surgery can be beneficial in severe cases of rheumatoid arthritis, when damaged joints no longer function well, and ulcerative colitis, when the colon can no longer perform its job.

While some people with more severe autoimmune conditions elect to take immunosuppressant medication, others manage their disease with a combination of lifestyle changes and a more affordable, moderate approach to medications. Everyone is different, so it’s important to discuss all of your options with your doctor before choosing a treatment.

Why Choose an Alternative to Tofacitinib?

Xeljanz is a Janus kinase inhibitor. Though not a biologic drug, it works similarly to one suppressing immune system activity. Unlike those injectable medications, however, Xeljanz comes in pill form.
Like biologic drugs, tofacitinib can limit your body’s natural ability to fight viral, bacterial and fungal infections. It can also cause diarrhea, hives, shortness of breath and dark urine. The FDA has investigated Xeljanz’s safety profile in the following ways:

  • Sept. 1, 2021: The FDA’s large-scale clinical trial review concluded that Xeljanz poses a risk of several health care problems such as cancer, heart attacks, blood clots, stroke and death. This study compared Xeljanz to TNF blockers, a class of biologic drugs that includes Humira.
  • July 26, 2019: The FDA approved a boxed warning that alerted the public to the fact that Xeljanz can lead to an increased risk of blood clots or death while taking a 10 milligram, twice-daily dose.
  • Feb. 25, 2019: The FDA warned the public that Xeljanz may raise the risk of blood clots in the lungs in patients with rheumatoid arthritis.

Currently, the Xeljanz boxed warning tells the public of drugs that can carry serious side effects — including possible disability or death of a patient or a patient’s developing fetus. This warning does not mean that Xeljanz will necessarily cause these side effects, but it’s important to note that they’re possible. Patients who took Xeljanz and experienced blood clots, heart problems or cancer have filed Xeljanz lawsuit against Pfizer, the manufacturer.

Is Generic Xeljanz Available?

There isn’t currently a generic Xeljanz drug. In 2021, Pfizer took legal action against Sinotherapeutics, a Chinese company that wanted to release a generic, extended-release version of Xeljanz.

If you’re interested in generic tofacitinib, you may have to wait quite a while to obtain access to this drug. Pfizer filed this lawsuit to block Sinotherapeutics’ generic until the original extended-release Xeljanz patent expires in 2034.



Xeljanz vs. Other Drugs

If you’re seeking strong rheumatoid arthritis drugs or ulcerative colitis meditations, disease-modifying antirheumatic drugs and biologics may be good options to discuss with your doctor. Consider the differences between Xeljanz and the drugs listed below.

Xeljanz vs. Otezla

Otezla (apremilast) is a disease-modifying antirheumatic drug that inhibits an enzyme (phosphodiesterase) to block inflammation in the body. If you’re thinking about switching from Xeljanz to apremilast, speak with your doctor.

Key Otezla Facts
  • Otezla is typically prescribed for psoriatic arthritis and psoriasis.
  • It may not work as well if you have a condition like ulcerative colitis.
  • Many people have stomach symptoms such as diarrhea and nausea when beginning their Otezla treatment. These may or may not subside over time.
  • Otezla can also treat oral ulcers in patients with Bechet’s Disease.

Aprelimast may cause mental health changes, including low mood or thoughts of suicide. If you notice any unusual changes in the way you think or feel while taking this medication, alert your doctor immediately.

Xeljanz vs. Azulfidine

Azulfidine (sulfasalazine) is a Pfizer-made DMARD that’s often one of the first drugs prescribed to patients with inflammatory arthritis or inflammatory bowel conditions. There are key differences between Xeljanz and sulfasalazine.

Key Azulfidine Facts
  • You’ll usually have to take sulfasalazine multiple times per day. Some patients take it as many as three times per day.
  • Your doctor may not prescribe Azulfadine if you're allergic to sulfa medications. Sulfasalazine can cause similar reactions.
  • This medication can interfere with a few medications such as warfarin (a common blood thinner) and certain diabetes medications.

Sulfasalazine is generally regarded as a safe drug for inflammatory conditions, but it’s not right for everyone. Talk to your doctor to determine whether Azulfadine could adequately treat your disease activity.

Xeljanz vs. Humira

Humira (adalimumab) is an injectable biologic medication that works to suppress immune system activity. There are a few significant differences between adalimumab and Xeljanz.

Key Humira Facts
  • Humira is a tumor necrosis factor blocker, not a JAK inhibitor. This gives it a different safety profile than Xeljanz.
  • If you use Humira, your doctor will likely ask you to get tested for tuberculosis regularly.
  • Humira is one of the oldest biologic drugs, as doctors have prescribed it for more than 20 years. This longevity can sometimes make patients feel more comfortable about its safety profile.

Like Xeljanz, Humira has a black box warning that draws attention to its ability to suppress the immune system in susceptible individuals enough to cause serious infections or death. It’s also responsible for the growth of some cancers, including lymphoma, and a lupus-like syndrome that typically stops when you stop taking the medication.

How to Switch to a Xeljanz Alternative

If you have concerns about taking Xeljanz, your doctor will review your health history and current medications and supplements. He or she will also discuss medications you’ve tried before to assess how well they worked (or didn’t work) for you.

Don’t quit Xeljanz cold turkey, as you may have side effects, including flare-ups in disease activity. Always create a plan with your provider to stop your current medication before changing to a new one. Additionally, your doctor should be aware of all the over-the-counter drugs and supplements you’re taking to ensure they don’t interact with your new medication.

It’s possible to find an effective replacement medication for Xeljanz. Discuss your options with your doctor as well as which dietary and lifestyle changes may benefit your specific case.



Please seek the advice of a medical professional before making health care decisions.