{"id":66707,"date":"2025-05-01T13:49:54","date_gmt":"2025-05-01T13:49:54","guid":{"rendered":"https:\/\/medsbase.com\/?post_type=product&#038;p=66707"},"modified":"2026-04-30T10:23:27","modified_gmt":"2026-04-30T10:23:27","slug":"tofe","status":"publish","type":"product","link":"https:\/\/medsbase.com\/ro\/product\/tofe\/","title":{"rendered":"Tofe"},"content":{"rendered":"<p><!-- medsbase-tldr-answer --><\/p>\n<div style=\"background:#fff8e1;border-left:4px solid #f5a623;padding:18px 22px;margin:0 0 24px 0;border-radius:4px;\">\n<h3 class=\"wp-block-heading\" style=\"margin:0 0 8px 0;font-size:16px;font-weight:700;\">\u26a1 R\u0103spuns rapid \u2014 Ce este Tofe?<\/h3>\n<p style=\"margin:0;\"><strong>Tofe<\/strong> este un comprimat oral de la Intas Pharmaceuticals care con\u021bine <strong>tofacitinib<\/strong> \u2014 un medicament <strong>Inhibitor al Janus kinazei (JAK)<\/strong> care blocheaz\u0103 semnalizarea intracelular\u0103 a citokinelor prin JAK1 \u0219i JAK3 (cu o anumit\u0103 activitate JAK2). Disponibil la <strong>5 mg<\/strong>. Doz\u0103 standard: <strong>5 mg de dou\u0103 ori pe zi (sau 11 mg o dat\u0103 pe zi cu eliberare prelungit\u0103)<\/strong>. Utilizat\u0103 pentru <strong>artrita reumatoid\u0103 moderat p\u00e2n\u0103 la sever\u0103<\/strong> \u0219i alte afec\u021biuni autoimune dup\u0103 e\u0219ecul DMARD-urilor conven\u021bionale. <strong>Poart\u0103 un avertisment FDA \u00een caset\u0103 neagr\u0103<\/strong> pentru infec\u021bii grave, evenimente cardiovasculare adverse majore (MACE), tromboz\u0103 \u0219i malignitate \u2014 \u00een special la pacien\u021bii peste 50 de ani cu cel pu\u021bin un factor de risc cardiovascular. <strong>Teste obligatorii pre-tratament: tuberculoz\u0103 latent\u0103, hepatit\u0103 B, hepatit\u0103 C, hemogram\u0103 cu formula leucocitar\u0103, teste de func\u021bie hepatic\u0103, panel lipidic \u0219i statut varicela-zoster.<\/strong> Nu este un medicament de prim\u0103 inten\u021bie \u2014 se rezerv\u0103 pentru pacien\u021bii care au e\u0219uat la metotrexat sau DMARD-uri biologice.<\/p>\n<\/div>\n<p><!-- medsbase-specialist-strip --><\/p>\n<div style=\"background:#fff3f3;border-left:4px solid #d9534f;padding:16px 20px;margin:0 0 24px 0;border-radius:4px;font-size:14px;\"><strong>\u2695 Medicament sub supraveghere specializat\u0103 \u2014 necesit\u0103 monitorizare clinic\u0103.<\/strong> Acesta este un medicament imunomodulator serios cu cerin\u021be specifice de screening pre-tratament, avertismente black-box \u0219i monitorizare obligatorie \u00een laborator. Ar trebui s\u0103 fie prescris \u0219i supravegheat de un reumatolog, gastroenterolog, dermatolog sau alt specialist cu experien\u021b\u0103 \u00een utilizarea sa. Nu <strong>prime\u0219te,<\/strong> autoprescrie\u021bi, nu ajusta\u021bi singur doza \u0219i nu \u00eencepe\u021bi\/opri\u021bi tratamentul f\u0103r\u0103 indica\u021biile medicului prescriptor. Furniza\u021bi \u00eentotdeauna medicului tratant re\u021beta actual\u0103 \u00eenainte de a comanda de la MedsBase.<\/div>\n<div class=\"medsbase-trust-strip\" style=\"background:#f4f6f8;border:1px solid #e1e4e8;border-radius:4px;padding:14px 18px;margin:18px 0;display:flex;flex-wrap:wrap;gap:14px;font-size:0.95em;\"><span>\u2705 <strong>Certificat WHO-GMP<\/strong> produc\u0103tor<\/span><span>\ud83d\udce6 <strong>Ambalaj discret<\/strong><\/span><span>\ud83c\udf0d <strong>Livrare \u00een toat\u0103 lumea<\/strong><\/span><span>\ud83d\udcac <a href=\"\/ro\/reviews\/\">Peste 1.400 de recenzii ale clien\u021bilor<\/a><\/span><\/div>\n<p class=\"medsbase-reship-line\" style=\"font-size:14px;color:#444;margin:8px 0 18px;\">\ud83d\udce6 Fiecare comand\u0103 este acoperit\u0103 de politica noastr\u0103 de <a href=\"https:\/\/medsbase.com\/ro\/medsbase-re-shipment-assurance-policy\/\"><strong>Politica noastr\u0103 de Reexpediere Garantat\u0103<\/strong><\/a> \u2014 dac\u0103 coletul dumneavoastr\u0103 nu sose\u0219te \u00een 20 de zile lucr\u0103toare, \u00eel relivr\u0103m.<\/p>\n<h3>De ce s\u0103 comanzi de la MedsBase<\/h3>\n<p>Medicamentele noastre generice sunt procurate de la produc\u0103tori certifica\u021bi WHO-GMP \u0219i expediate la nivel mondial \u00een ambalaje discrete \u0219i simple \u2014 f\u0103r\u0103 denumirea medicamentului pe exteriorul coletului. Pl\u0103\u021bile cu cardul sunt procesate printr-un procesor reglementat (descrierile de pe extrasul de cont includ un procesor de pl\u0103\u021bi cu card reglementat \u2014 niciodat\u0103 \u201cMedsBase\u201d sau numele vreunui medicament). Accept\u0103m \u0219i criptomonede \u0219i transferuri bancare SEPA. Fiecare comand\u0103 este sus\u021binut\u0103 de Politica noastr\u0103 de Asigurare pentru Relivrare.<\/p>\n<h2 class=\"wp-block-heading\">Ce este Tofe?<\/h2>\n<p>Tofe este un comprimat oral fabricat de Intas Pharmaceuticals care con\u021bine <strong>tofacitinib<\/strong>, o molecul\u0103 mic\u0103 <strong>Inhibitor al Janus kinazei (JAK)<\/strong>. Inhibitorii JAK reprezint\u0103 o clas\u0103 nou\u0103 de medicamente antireumatice modificatoare de boal\u0103 sintetice \u021bintite (tsDMARD) care blocheaz\u0103 cascada de semnalizare intracelular\u0103 declan\u0219at\u0103 atunci c\u00e2nd citokinele inflamatoare se leag\u0103 de receptorii lor de pe celulele imune.<\/p>\n<p>Tofe este echivalentul generic al tofacitinibului de la Intas \u2014 primul inhibitor oral al JAK aprobat (Xeljanz, Pfizer) cu cele mai largi indica\u021bii regulate din clas\u0103: artrit\u0103 reumatoid\u0103, artrit\u0103 psoriazic\u0103, spondilit\u0103 anchilozant\u0103, colit\u0103 ulceroas\u0103 \u0219i artrit\u0103 idiopatic\u0103 juvenil\u0103 poliarticular\u0103. Spre deosebire de biologicile injectabile mai vechi (inhibitori TNF, inhibitori IL-6), tofacitinibul se administreaz\u0103 sub form\u0103 de comprimate, are un debut rapid (\u00eembun\u0103t\u0103\u021bire clinic\u0103 \u00een 2\u20134 s\u0103pt\u0103m\u00e2ni) \u0219i ac\u021bioneaz\u0103 pe o cale molecular\u0103 diferit\u0103 \u2014 f\u0103c\u00e2ndu-l o op\u021biune util\u0103 pentru pacien\u021bii care nu au r\u0103spuns la DMARD-uri conven\u021bionale sau la una sau mai multe biologice. Dovezi pivotale: ORAL Standard, ORAL Scan, ORAL Start (artrit\u0103 reumatoid\u0103), OCTAVE Induction\/Sustain (colit\u0103 ulceroas\u0103) \u0219i OPAL Broaden\/Beyond (artrit\u0103 psoriazic\u0103).<\/p>\n<h2 class=\"wp-block-heading\">Cum func\u021bioneaz\u0103 Tofe?<\/h2>\n<p>Multe citokine inflamatorii (IL-6, IFN-\u03b3, GM-CSF, IL-2, IL-4, IL-15, IL-21 \u0219i altele) semnalizeaz\u0103 \u00een interiorul celulelor prin activarea c\u0103ii <strong>JAK-STAT<\/strong>. C\u00e2nd citokina se leag\u0103 de receptorul s\u0103u, enzimele JAK fosforileaz\u0103 proteinele STAT, care apoi migreaz\u0103 \u00een nucleu \u0219i activeaz\u0103 genele care declan\u0219eaz\u0103 inflama\u021bia, activarea celulelor T \u0219i proliferarea sinovial\u0103.<\/p>\n<ul>\n<li><strong>Tofacitinib blocheaz\u0103 JAK1 \u0219i JAK3 (cu o anumit\u0103 activitate asupra JAK2)<\/strong> \u00een interiorul celulei, \u00eentrerup\u00e2nd semnalizarea pentru multiple citokine inflamatorii simultan.<\/li>\n<li><strong>Efect larg asupra semnaliz\u0103rii citokinelor<\/strong> \u2014 deoarece multiple receptori de citokine folosesc JAK1\/JAK2\/JAK3\/TYK2 \u00een diferite combina\u021bii, un singur inhibitor JAK atenueaz\u0103 multe c\u0103i inflamatorii deodat\u0103. Acest lucru ofer\u0103 beneficii clinice rapide, dar explic\u0103 \u0219i semnalele de infec\u021bie \u0219i malignitate.<\/li>\n<li><strong>Inhibi\u021bie reversibil\u0103<\/strong> \u2014 efectele dispar \u00een decurs de 1\u20132 zile dup\u0103 \u00eentreruperea medicamentului. Util \u00eenainte de interven\u021bii chirurgicale sau \u00een timpul infec\u021biilor.<\/li>\n<\/ul>\n<p>\u00cenceperea beneficiului simptomatic: ameliorarea durerii articulare la <strong>2\u20134 s\u0103pt\u0103m\u00e2ni<\/strong>; r\u0103spunsul clinic maxim la 3\u20136 luni. \u00cencetinirea radiografic\u0103 a deterior\u0103rii articula\u021biilor necesit\u0103 12 luni de administrare consecvent\u0103 pentru a fi demonstrat\u0103.<\/p>\n<h2 class=\"wp-block-heading\">Utiliz\u0103ri \u0219i indica\u021bii<\/h2>\n<ul>\n<li><strong>Poliartrit\u0103 reumatoid\u0103 moderat-sever\u0103<\/strong> \u2014 dup\u0103 r\u0103spuns inadecvat la metotrexat sau alte DMARD-uri<\/li>\n<li><strong>Colit\u0103 ulceroas\u0103 moderat p\u00e2n\u0103 la sever\u0103<\/strong> \u2014 dup\u0103 e\u0219ecul terapiei conven\u021bionale \u0219i biologice<\/li>\n<li><strong>Artrit\u0103 psoriazic\u0103<\/strong> \u2014 dup\u0103 r\u0103spuns inadecvat la DMARD-uri<\/li>\n<li><strong>Spondilit\u0103 anchilozant\u0103<\/strong> \u2014 dup\u0103 r\u0103spuns inadecvat la inhibitori de TNF<\/li>\n<li><strong>Artrit\u0103 idiopatic\u0103 juvenil\u0103 poliarticular\u0103<\/strong> (v\u00e2rsta 2+)<\/li>\n<\/ul>\n<p>Tofe este <strong>prime\u0219te,<\/strong> terapia de prim\u0103 linie pentru oricare dintre aceste afec\u021biuni. Este rezervat\u0103 pentru pacien\u021bii care au e\u0219uat (sau nu pot tolera) <strong>metotrexat<\/strong> \u0219i, conform ghidului actual FDA, ideal \u0219i <strong>un inhibitor TNF<\/strong> \u00eenainte de ini\u021bierea inhibitorului JAK \u2014 \u00een special la pacien\u021bii cu v\u00e2rsta de 50+ ani cu unul sau mai mul\u021bi factori de risc cardiovascular, unde studiul ORAL Surveillance a demonstrat rate mai mari de MACE \u0219i malignitate fa\u021b\u0103 de inhibitorii TNF.<\/p>\n<h2 class=\"wp-block-heading\">Evalu\u0103ri obligatorii \u00eenainte de a \u00eencepe Tofe<\/h2>\n<p>Fiecare pacient trebuie s\u0103 completeze aceste verific\u0103ri \u00eenainte de prima doz\u0103. Omiterea lor este cea mai frecvent\u0103 cauz\u0103 a evenimentelor adverse grave la inhibitorii JAK.<\/p>\n<ul>\n<li><strong>Screening pentru tuberculoz\u0103 latent\u0103<\/strong> \u2014 QuantiFERON-TB Gold sau T-SPOT (preferate) sau test tuberculinic cutanat. Inhibi\u021bia JAK reactiveaz\u0103 tuberculoza latent\u0103 la ~1% dintre pacien\u021bi. Dac\u0103 este pozitiv, completa\u021bi cel pu\u021bin o lun\u0103 de izoniazid\u0103 (sau echivalent) \u00eenainte de a \u00eencepe tratamentul.<\/li>\n<li><strong>Hepatitis B<\/strong> \u2014 HBsAg, anti-HBc, anti-HBs. HBV cronic pozitiv necesit\u0103 consult hepatologic \u0219i acoperire antiviral\u0103 (entecavir sau tenofovir) pe durata terapiei cu JAK.<\/li>\n<li><strong>Hepatita C<\/strong> \u2014 anti-HCV, confirma\u021bi cu HCV RNA dac\u0103 este pozitiv. Trata\u021bi mai \u00eent\u00e2i HCV dac\u0103 este prezent.<\/li>\n<li><strong>Statut HIV<\/strong> \u2014 nu este o contraindica\u021bie absolut\u0103, dar necesit\u0103 consult specializat.<\/li>\n<li><strong>Hemogram\u0103 complet\u0103 cu diferen\u021bial<\/strong> \u2014 nu \u00eencepe\u021bi dac\u0103 ANC &lt; 1,0 \u00d7 10&amp;sup9;\/L, ALC &lt; 0,5 \u00d7 10&amp;sup9;\/L sau hemoglobin\u0103 &lt; 9 g\/dL.<\/li>\n<li><strong>Func\u021bia hepatic\u0103<\/strong> \u2014 nu \u00eencepe\u021bi dac\u0103 ALT\/AST &gt; 3\u00d7 limita superioar\u0103 normal\u0103.<\/li>\n<li><strong>Func\u021bia renal\u0103<\/strong> \u2014 doza se stabile\u0219te \u00een func\u021bie de eGFR.<\/li>\n<li><strong>Profil lipidic<\/strong> \u2014 colesterol total de baz\u0103, LDL, HDL, trigliceride. Inhibitorii JAK cresc lipidele; repeta\u021bi la 8 s\u0103pt\u0103m\u00e2ni \u0219i anual.<\/li>\n<li><strong>Test de sarcin\u0103<\/strong> la femeile \u00een v\u00e2rst\u0103 fertil\u0103. Este necesar\u0103 contracep\u021bie eficient\u0103 \u00een timpul tratamentului \u0219i pentru ~1 s\u0103pt\u0103m\u00e2n\u0103 dup\u0103 ultima doz\u0103.<\/li>\n<li><strong>Stare Varicella-zoster<\/strong> \u2014 istoric de varicel\u0103 sau serologie VZV. Dac\u0103 pacientul este seronegativ, vaccina\u021bi cu vaccinul anti-varicel\u0103 cu cel pu\u021bin 4 s\u0103pt\u0103m\u00e2ni \u00eenainte de a \u00eencepe terapia cu JAK.<\/li>\n<li><strong>Evaluare vaccinare<\/strong> \u2014 actualiza\u021bi toate <em>vaccinurile inactivate<\/em> (grip\u0103, pneumococ, COVID-19, HPV, herpes zoster recombinant Shingrix). <strong>Vaccinurile cu virus viu sunt contraindicate \u00een timpul tratamentului<\/strong> \u2014 acorda\u021bi cel pu\u021bin 4 s\u0103pt\u0103m\u00e2ni \u00eenainte de \u00eencepere.<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Doza de Tofe \u0219i modul de administrare<\/h2>\n<p>Tofe este disponibil \u00een <strong>5 mg<\/strong>. Doza depinde de indica\u021bie, func\u021bia renal\u0103 \u0219i medicamentele concomitente.<\/p>\n<ul>\n<li><strong>Artrit\u0103 reumatoid\u0103, artrit\u0103 psoriazic\u0103, spondilit\u0103 anchilozant\u0103:<\/strong> 5 mg de dou\u0103 ori pe zi SAU 11 mg cu eliberare prelungit\u0103 o dat\u0103 pe zi<\/li>\n<li><strong>Induc\u021bie \u00een colit\u0103 ulceroas\u0103 (8 s\u0103pt\u0103m\u00e2ni):<\/strong> 10 mg de dou\u0103 ori pe zi; reducere la 5 mg de dou\u0103 ori pe zi pentru men\u021binere dup\u0103 remisie<\/li>\n<li><strong>Artrit\u0103 idiopatic\u0103 juvenil\u0103 poliarticular\u0103 (greutate \u2265 40 kg):<\/strong> 5 mg de dou\u0103 ori pe zi<\/li>\n<li><strong>Ajustare renal\u0103:<\/strong> moderat-sever\u0103 (eGFR &lt; 60 mL\/min) \u2192 5 mg o dat\u0103 pe zi; nu este recomandat la eGFR &lt; 15<\/li>\n<li><strong>Ajustare hepatic\u0103:<\/strong> moderat\u0103 (Child-Pugh B) \u2192 5 mg o dat\u0103 pe zi; evita\u021bi \u00een cazuri severe<\/li>\n<li><strong>Cu alimente sau pe stomacul gol:<\/strong> poate fi luat \u00een orice fel; lua\u021bi la acelea\u0219i ore \u00een fiecare zi<\/li>\n<\/ul>\n<h3 class=\"wp-block-heading\">Cum s\u0103 lua\u021bi Tofe corect<\/h3>\n<ol>\n<li><strong>Nu \u00eencepe\u021bi f\u0103r\u0103 investiga\u021biile pre-tratament enumerate mai sus.<\/strong> Fiecare doz\u0103 ratat\u0103 cre\u0219te riscul unui eveniment grav.<\/li>\n<li><strong>\u00cenghi\u021bi\u021bi comprimatul \u00eentreg cu ap\u0103<\/strong> \u2014 nu zdrobi\u021bi, nu desp\u0103r\u021bi\u021bi \u0219i nu mesteca\u021bi. Tofacitinib cu eliberare imediat\u0103 poate fi desp\u0103r\u021bit dac\u0103 este scor\u021bat; formele cu eliberare prelungit\u0103 de 11 mg trebuie \u00eenghi\u021bite \u00eentregi.<\/li>\n<li><strong>Aceea\u0219i or\u0103 \u00een fiecare zi.<\/strong> Consecven\u021ba este mai important\u0103 dec\u00e2t momentul relativ la mese.<\/li>\n<li><strong>Dac\u0103 se uit\u0103 o doz\u0103<\/strong>, lua\u021bi-l c\u00e2t mai cur\u00e2nd posibil \u00een aceea\u0219i zi. Dac\u0103 urm\u0103toarea doz\u0103 programat\u0103 este aproape, omite\u021bi cea ratat\u0103 \u2014 nu lua\u021bi o doz\u0103 dubl\u0103.<\/li>\n<li><strong>Pauz\u0103 \u00een timpul infec\u021biilor<\/strong> \u2014 \u00eentrerupe\u021bi Tofe la primele semne de infec\u021bie grav\u0103 (febr\u0103 \u00eenalt\u0103, tuse productiv\u0103, pielonefrit\u0103, celulit\u0103, herpes zoster). Relua\u021bi numai dup\u0103 ce infec\u021bia s-a rezolvat \u0219i medicul prescriptor a evaluat situa\u021bia.<\/li>\n<li><strong>Pauz\u0103 \u00eenainte de interven\u021bii chirurgicale elective.<\/strong> \u00centrerupe\u021bi 3\u20137 zile (5 timpi de \u00eenjum\u0103t\u0103\u021bire) \u00eenainte de o interven\u021bie chirurgical\u0103 major\u0103; relua\u021bi dup\u0103 1\u20132 s\u0103pt\u0103m\u00e2ni, odat\u0103 ce vindecarea pl\u0103gii este \u00een curs \u0219i f\u0103r\u0103 infec\u021bii.<\/li>\n<li><strong>Monitorizare de laborator continu\u0103<\/strong> \u2014 hemogram\u0103 + teste hepatice la <strong>s\u0103pt\u0103m\u00e2nile 4, 8, 12<\/strong>, apoi la fiecare 3 luni. Profil lipidic la <strong>s\u0103pt\u0103m\u00e2na 8<\/strong>, apoi anual. Nu rata\u021bi aceste teste.<\/li>\n<li><strong>Raporta\u021bi imediat orice tuse nou\u0103, febr\u0103, transpira\u021bii nocturne, pierdere neexplicat\u0103 \u00een greutate, dureri toracice, umfl\u0103turi la picioare, sensibilitate la nivelul gambei sau dificult\u0103\u021bi de respira\u021bie<\/strong> \u2014 acestea pot semnala o infec\u021bie grav\u0103, evenimente cardiovasculare majore adverse (MACE) sau tromboz\u0103.<\/li>\n<li><strong>Evita\u021bi vaccinurile cu virus viu.<\/strong> Vaccinurile inactivate sunt sigure \u0219i recomandate (grip\u0103, pneumococ, Shingrix).<\/li>\n<li><strong>Protec\u021bie solar\u0103 zilnic\u0103 cu SPF 50<\/strong> \u2014 inhibitorii JAK cresc riscul de cancer cutanat non-melanom. Este recomandat un control dermatologic anual pentru pacien\u021bii cu piele deschis\u0103 la culoare, antecedente de cancer cutanat sau peste 12 luni de terapie.<\/li>\n<\/ol>\n<h2 class=\"wp-block-heading\">Efecte secundare ale Tofe<\/h2>\n<div style=\"background:#fff3f3;border-left:4px solid #d9534f;padding:14px 18px;margin:12px 0;border-radius:4px;font-size:14px;\"><strong>\u26a0\ufe0f Avertisment FDA Black-Box.<\/strong> Bazat pe studiul ORAL Surveillance (2021) care compar\u0103 tofacitinib cu inhibitorii TNF la pacien\u021bii cu artrit\u0103 reumatoid\u0103 \u00een v\u00e2rst\u0103 de 50+ ani cu cel pu\u021bin un factor de risc cardiovascular \u2014 \u0219i extrapolat la \u00eentreaga clas\u0103 de inhibitori JAK:<\/p>\n<ul style=\"margin:8px 0 0 0;\">\n<li><strong>Infec\u021bii grave<\/strong> \u2014 bacteriene, fungice, virale, micobacteriene (inclusiv reactivarea tuberculozei), oportuniste<\/li>\n<li><strong>Evenimente cardiovasculare majore adverse (MACE)<\/strong> \u2014 infarct miocardic, accident vascular cerebral, deces cardiovascular, la un ritm mai ridicat dec\u00e2t cu inhibitori TNF \u00een popula\u021bia cu risc ridicat<\/li>\n<li><strong>Tromboz\u0103<\/strong> \u2014 tromboz\u0103 venoas\u0103 profund\u0103, embolie pulmonar\u0103, tromboz\u0103 arterial\u0103<\/li>\n<li><strong>Neoplazie<\/strong> \u2014 limfom, cancer pulmonar (\u00een special la fum\u0103torii actuali\/fo\u0219ti fum\u0103tori), cancer cutanat non-melanom<\/li>\n<li><strong>Mortalitate<\/strong> \u2014 mortalitatea din toate cauzele a fost numeric mai mare cu tofacitinib vs inhibitori TNF \u00een cohorta cu risc ridicat<\/li>\n<\/ul>\n<p style=\"margin:8px 0 0 0;\">Conform etichet\u0103rii actuale FDA, inhibitorii JAK trebuie rezerva\u021bi pentru pacien\u021bii cu r\u0103spuns inadecvat sau intoleran\u021b\u0103 la unul sau mai mul\u021bi inhibitori TNF, cu excep\u021bia cazurilor \u00een care alternativele nu sunt potrivite.<\/p>\n<\/div>\n<p><strong>Efecte secundare frecvente:<\/strong><\/p>\n<ul>\n<li>Infec\u021bii ale tractului respirator superior, nazofaringit\u0103, sinuzit\u0103<\/li>\n<li>Grea\u021b\u0103, diaree<\/li>\n<li>Dureri de cap<\/li>\n<li>Erup\u021bie cutanat\u0103, acnee<\/li>\n<li>Herpes simplex \u0219i <strong>reactivare herpes zoster (zona zoster)<\/strong> \u2014 inciden\u021b\u0103 semnificativ mai mare dec\u00e2t \u00een popula\u021bia general\u0103, \u00een special la popula\u021biile asiatice<\/li>\n<li>Cre\u0219tere LDL, HDL \u0219i colesterol total<\/li>\n<li>Cre\u0219terea ALT\/AST \u0219i creatin-kinazei<\/li>\n<li>Limfopenie, neutropenie, anemie<\/li>\n<\/ul>\n<p><strong>Mai pu\u021bin frecvente, dar importante:<\/strong><\/p>\n<ul>\n<li>Pneumonie (bacterian\u0103 \u0219i oportunist\u0103, inclusiv <em>Pneumocystis<\/em>)<\/li>\n<li>Celulit\u0103, infec\u021bie a tractului urinar, diverticulit\u0103 (risc crescut de perfora\u021bie la pacien\u021bii \u00een v\u00e2rst\u0103 trata\u021bi cu tofacitinib)<\/li>\n<li>Reactivarea hepatitei B<\/li>\n<li>Boal\u0103 pulmonar\u0103 intersti\u021bial\u0103<\/li>\n<li>Perfora\u021bie gastrointestinal\u0103 (\u00een special la administrarea concomitent\u0103 cu AINS sau corticoesteroide)<\/li>\n<\/ul>\n<p><strong>Rare, dar grave \u2014 c\u0103uta\u021bi ajutor medical imediat:<\/strong><\/p>\n<ul>\n<li>Tuberculoz\u0103 activ\u0103 sau infec\u021bie fungic\u0103 diseminat\u0103 (febr\u0103, transpira\u021bii nocturne, tuse productiv\u0103, pierdere \u00een greutate)<\/li>\n<li>Infarct miocardic, accident vascular cerebral (durere \u00een piept, durere \u00een bra\u021b sau maxilar, sl\u0103biciune brusc\u0103 unilateral\u0103, c\u0103derea fe\u021bei)<\/li>\n<li>Tromboz\u0103 venoas\u0103 profund\u0103\/embolie pulmonar\u0103 (umflare unilateral\u0103 a gambei cu sensibilitate la nivelul gastrocnemelui, dispnee brusc\u0103, durere toracic\u0103 pleuristic\u0103)<\/li>\n<li>Herpes zoster diseminat, encefalit\u0103<\/li>\n<li>Limfadenopatie nou\u0103 sau pier pierdere neexplicat\u0103 \u00een greutate (posibil\u0103 limfom)<\/li>\n<li>Reac\u021bie cutanat\u0103 sever\u0103 (SJS, TEN, DRESS)<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Avertismente \u0219i precau\u021bii<\/h2>\n<ul>\n<li><strong>V\u00e2rsta peste 65 de ani \u0219i\/sau fum\u0103tori actuali\/fo\u0219ti<\/strong> \u2014 risc semnificativ mai mare de evenimente cardiovasculare majore (MACE), malignitate \u0219i mortalitate. Utiliza\u021bi doar atunci c\u00e2nd alternativele (inhibitori TNF, inhibitori IL-6) sunt nepotrivite; prefera\u021bi cea mai mic\u0103 doz\u0103 eficient\u0103.<\/li>\n<li><strong>Istoric de infarct miocardic, accident vascular cerebral, tromboembolism venos (VTE), malignitate activ\u0103 sau boal\u0103 limfoproliferativ\u0103<\/strong> \u2014 contraindica\u021bie relativ\u0103 sau absolut\u0103; decizie de specialitate.<\/li>\n<li><strong>Infec\u021bie activ\u0103 grav\u0103<\/strong> \u2014 nu \u00eencepe\u021bi. Suspenda\u021bi \u00een timpul afec\u021biunilor febrile.<\/li>\n<li><strong>Reactiva\u021bie herpes zoster<\/strong> \u2014 frecvent\u0103 \u00een special. Vaccina\u021bi cu vaccin recombinat \u00eempotriva herpes zoster (Shingrix) cu cel pu\u021bin 4 s\u0103pt\u0103m\u00e2ni \u00eenainte de \u00eenceperea tratamentului, dac\u0103 v\u00e2rsta \u2265 50 de ani sau dac\u0103 sunt \u00eendeplinite alte criterii de eligibilitate.<\/li>\n<li><strong>Infec\u021bii cronice\/recurente, catetere permanente, interven\u021bii chirurgicale intracraniene\/intraabdominale recente<\/strong> \u2014 evaluare individualizat\u0103 risc-beneficiu; consult de specialitate.<\/li>\n<li><strong>Limfopenie, neutropenie, anemie<\/strong> \u2014 \u00eentrerupe\u021bi dac\u0103 num\u0103rul de limfocite (ALC) &lt; 0,5, num\u0103rul de neutrofile (ANC) &lt; 1,0 sau hemoglobina (Hb) &lt; 8 g\/dL. Relua\u021bi la o doz\u0103 mai mic\u0103 dup\u0103 recuperare.<\/li>\n<li><strong>Cre\u0219tere a nivelului lipidelor<\/strong> \u2014 trata\u021bi conform riscului cardiovascular; statinele nu interac\u021bioneaz\u0103 semnificativ cu tofacitinib.<\/li>\n<li><strong>Boal\u0103 diverticular\u0103<\/strong> \u2014 risc crescut de perfora\u021bie intestinal\u0103, \u00een special la v\u00e2rstnici care iau tofacitinib concomitent cu AINS sau corticoesteroizi.<\/li>\n<li><strong>Sarcina \u0219i al\u0103ptarea<\/strong> \u2014 evita\u021bi. Este necesar\u0103 contracep\u021bie eficient\u0103 \u00een timpul tratamentului \u0219i pentru cel pu\u021bin 1 s\u0103pt\u0103m\u00e2n\u0103 dup\u0103 ultima doz\u0103. Nu este recomandat \u00een timpul al\u0103pt\u0103rii.<\/li>\n<li><strong>Utilizare pediatric\u0103<\/strong> \u2014 tofacitinib este aprobat pentru poliartrita juvenil\u0103 idiopatic\u0103 de la v\u00e2rsta de 2 ani.<\/li>\n<li><strong>Vaccinuri cu virus viu<\/strong> \u2014 contraindicate \u00een timpul tratamentului. Dac\u0103 este necesar un vaccin cu virus viu (febr\u0103 galben\u0103, MMR booster, varicel\u0103, Zostavax pentru zona zoster, vaccin nazal viu pentru grip\u0103), administra\u021bi cel pu\u021bin cu 4 s\u0103pt\u0103m\u00e2ni \u00eenainte de \u00eenceperea tratamentului \u0219i a\u0219tepta\u021bi 1\u20132 s\u0103pt\u0103m\u00e2ni f\u0103r\u0103 medicament \u00eenainte de reluare.<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Contraindica\u021bii \u2014 Cine NU ar trebui s\u0103 ia Tofe<\/h2>\n<ul>\n<li>Hipersensibilitate cunoscut\u0103 la tofacitinib sau la orice excipient din compozi\u021bia tabletelor<\/li>\n<li>Infec\u021bie activ\u0103 grav\u0103 (bacterian\u0103, viral\u0103, fungic\u0103, micobacterian\u0103 \u2014 inclusiv TB activ\u0103)<\/li>\n<li>Hepatit\u0103 B cronic\u0103 netratat\u0103<\/li>\n<li>Afectare hepatic\u0103 sever\u0103 (Child-Pugh C)<\/li>\n<li>Insuficien\u021b\u0103 renal\u0103 sever\u0103 (FG &lt; 15 mL\/min)<\/li>\n<li>Limbopenie sever\u0103 (ALC &lt; 0,5), neutropenie (ANC &lt; 1,0) sau anemie (Hb &lt; 8 g\/dL)<\/li>\n<li>Sarcin\u0103<\/li>\n<li>Eveniment cardiovascular major recent (IM, AVC) \u00een ultimele 6 luni<\/li>\n<li>Neoplasm malign activ (altul dec\u00e2t cancerul de piele non-melanom tratat)<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Interac\u021biuni medicamentoase<\/h2>\n<table style=\"border-collapse:collapse;width:100%;margin:12px 0;\">\n<thead>\n<tr style=\"background:#2c7cb0;color:#fff;\">\n<th style=\"padding:10px;border:1px solid #ddd;text-align:left;\">Combina\u021bi cu<\/th>\n<th style=\"padding:10px;border:1px solid #ddd;text-align:left;\">Efect<\/th>\n<th style=\"padding:10px;border:1px solid #ddd;text-align:left;\">Ce s\u0103 face\u021bi<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Inhibitori puternici ai CYP3A4 (ketoconazol, ritonavir, claritromicin\u0103)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Cre\u0219te nivelurile de tofacitinib de ~2\u00d7<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Reduce\u021bi doza la jum\u0103tate (5 mg o dat\u0103 pe zi pentru AR; 5 mg de dou\u0103 ori pe zi pentru induc\u021bia UC).<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Inhibitori moderati ai CYP3A4 + inhibitori puternici ai CYP2C19 combina\u021bi (fluconazol)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Cre\u0219te nivelurile de tofacitinib<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Reduce\u021bi doza de tofacitinib ca \u00een cazul inhibitorilor puternici ai 3A4.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Inductori puternici ai CYP3A4 (rifampicin\u0103, carbamazepin\u0103, fenitoin\u0103, sun\u0103toare)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Niveluri sc\u0103zute de tofacitinib \u2014 posibil\u0103 pierdere a eficacit\u0103\u021bii<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Evita\u021bi combina\u021bia dac\u0103 este posibil; lua\u021bi \u00een considerare un alt tsDMARD.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Alte DMARD-uri biologice (adalimumab, etanercept, infliximab, tocilizumab, rituximab, abatacept)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Imunosupresie aditiv\u0103 \u2014 risc de infec\u021bie sever\u0103<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\"><strong>Nu combina\u021bi.<\/strong> Permite\u021bi o perioad\u0103 adecvat\u0103 de eliminare \u00eenainte de schimbare.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Al\u021bi inhibitori de JAK (upadacitinib, filgotinib)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Toxicitate aditiv\u0103 f\u0103r\u0103 beneficii suplimentare<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Utiliza\u021bi un singur inhibitor de JAK la un moment dat.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Imunosupresoare puternice (azatioprin\u0103, ciclosporin\u0103, tacrolimus, micofenolat) \u00een afara transplantului<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Risc aditiv de infec\u021bie \u0219i limfom<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Evita\u021bi \u00een afara set\u0103rilor de transplant. Pacien\u021bii transplanta\u021bi: decizie specialist.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Vaccinuri cu virus viu (MMR, varicel\u0103, zona viu, grip\u0103 nazal\u0103 viu, febr\u0103 galben\u0103, BCG)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Risc de infec\u021bie diseminat\u0103 cu tulpina vaccinului<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\"><strong>Contraindicate \u00een timpul tratamentului.<\/strong> Administra\u021bi cu 4+ s\u0103pt\u0103m\u00e2ni \u00eenainte de \u00eencepere sau a\u0219tepta\u021bi 1\u20132 s\u0103pt\u0103m\u00e2ni dup\u0103 \u00eentrerupere.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">AINE \u0219i corticoide concomitente<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Risc crescut de perfora\u021bie gastrointestinal\u0103 (\u00een special tofacitinib + v\u00e2rstnici + boal\u0103 diverticular\u0103)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Utiliza\u021bi cea mai mic\u0103 doz\u0103 eficient\u0103 pentru ambele; evita\u021bi combina\u021bia pe termen lung.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Metotrexat (doz\u0103 mic\u0103, s\u0103pt\u0103m\u00e2nal)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Combina\u021bie standard \u00een AR \u2014 f\u0103r\u0103 interac\u021biune farmacocinetic\u0103<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Continua\u021bi metotrexatul ca DMARD de fond; monitoriza\u021bi \u00een comun hemoleucograma \u0219i testele hepatice.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2 class=\"wp-block-heading\">Instruc\u021biuni de Depozitare<\/h2>\n<ul>\n<li>Se p\u0103streaz\u0103 la temperatura camerei, <strong>sub 30\u00b0C<\/strong>, \u00een ambalajul original blister.<\/li>\n<li>Proteja\u021bi de lumin\u0103 \u0219i umiditate. Nu p\u0103stra\u021bi \u00een baie.<\/li>\n<li>P\u0103stra\u021bi \u00een afara reach-ului copiilor \u2014 ingestia accidental\u0103 poate provoca imunosupresie sever\u0103.<\/li>\n<li>Nu utiliza\u021bi dup\u0103 data de expirare indicat\u0103 pe ambalaj.<\/li>\n<li>Returna\u021bi comprimatele neutilizate la farmacie pentru eliminare \u2014 nu le arunca\u021bi \u00een toalet\u0103 sau \u00een gunoiul menajer.<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Alternative conexe pe MedsBase<\/h2>\n<p>Alte medicamente utilizate \u00een tratamentul antiinflamator \u0219i autoimun disponibile al\u0103turi de acest produs:<\/p>\n<ul>\n<li><a href=\"https:\/\/medsbase.com\/ro\/barinat\/\"><strong>Barinat (baricitinib 2 \/ 4 mg) \u2014 inhibitor JAK1\/2 pentru AR<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/azoran\/\"><strong>Azoran (azathioprin\u0103 50 mg) \u2014 imunosupresor clasic DMARD<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/lefuheal\/\"><strong>Lefuheal (leflunomid\u0103) \u2014 DMARD oral pentru artrita reumatoid\u0103<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/conimune-me\/\"><strong>Conimune ME (ciclosporin\u0103) \u2014 inhibitor al calcineurinei<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/wysolone\/\"><strong>Wysolone (prednisolon 5 \/ 10 \/ 20 mg) \u2014 corticosteroid oral<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/medrol\/\"><strong>Medrol (metilprednisolon 4 \/ 8 \/ 16 mg) \u2014 corticosteroid oral<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/predniheal\/\"><strong>Predniheal (prednisolon) \u2014 corticosteroid oral<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/hisone\/\"><strong>Hisone (hidrocortizon) \u2014 steroid fiziologic de \u00eenlocuire<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/budez-cr\/\"><strong>Budez CR (budesonid\u0103) \u2014 corticosteroid cu ac\u021biune intestinal\u0103 pentru boala Crohn<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/kenacort\/\"><strong>Kenacort (triamcinolon) \u2014 corticosteroid sistemic<\/strong><\/a><\/li>\n<\/ul>\n<p>Explora\u021bi \u00eentreaga <a href=\"https:\/\/medsbase.com\/ro\/anti-inflammatory-autoimmune-care\/\">\u00cengrijire antiinflamatoare \u0219i autoimun\u0103<\/a> categorie.<\/p>\n<h2 id=\"faqs\">\u00centreb\u0103ri frecvente<\/h2>\n<h3 class=\"wp-block-heading\">C\u00e2nd voi sim\u021bi efectul lui Tofe?<\/h3>\n<p>Durerea articular\u0103 \u0219i rigiditatea matinal\u0103 se amelioraz\u0103 de obicei \u00een termen de <strong>2\u20134 s\u0103pt\u0103m\u00e2ni<\/strong>. R\u0103spunsul clinic maxim se ob\u021bine \u00een 3\u20136 luni. Dac\u0103 nu se observ\u0103 o ameliorare semnificativ\u0103 p\u00e2n\u0103 la 12\u201316 s\u0103pt\u0103m\u00e2ni la o doz\u0103 adecvat\u0103, majoritatea reumatologilor ar lua \u00een considerare trecerea la o terapie alternativ\u0103 \u021bintit\u0103 \u00een loc s\u0103 continue la nesf\u00e2r\u0219it.<\/p>\n<h3 class=\"wp-block-heading\">De ce am nevoie de teste pentru TB \u0219i hepatita B \u00eenainte de a \u00eencepe Tofe?<\/h3>\n<p>Inhibitorii JAK reactiveaz\u0103 infec\u021biile latente. Tuberculoza latent\u0103 se reactiveaz\u0103 la ~1% din pacien\u021bi, iar hepatita B cronic\u0103 poate avea o reactivare exploziv\u0103. Singura metod\u0103 de prevenire este testarea \u00eenainte de prima doz\u0103 \u0219i tratarea (sau acoperirea cu profilaxie antiviral\u0103) a oricui are rezultate pozitive. Omiterea acestor teste este cea mai frecvent\u0103 cauz\u0103 evitabil\u0103 de complica\u021bii grave \u00een terapia cu JAK.<\/p>\n<h3 class=\"wp-block-heading\">De ce exist\u0103 un avertisment de tip black-box pentru Tofe?<\/h3>\n<p>FDA a ad\u0103ugat avertismentul \u00een cutie neagr\u0103 pentru \u00eentreaga clas\u0103 \u00een septembrie 2021 dup\u0103 ce <strong>ORAL Surveillance<\/strong> a demonstrat c\u0103 tofacitinibul, la dozele aprobate pentru artrita reumatoid\u0103, a produs mai multe evenimente cardiovasculare majore (infarct miocardic, accident vascular cerebral, deces cardiovascular), mai multe malignit\u0103\u021bi (\u00een special cancer pulmonar la fum\u0103tori), mai multe cheaguri de s\u00e2nge \u0219i o mortalitate general\u0103 mai mare dec\u00e2t inhibitorii TNF \u2014 \u00een special la pacien\u021bii cu AR \u00een v\u00e2rst\u0103 de 50+ ani cu cel pu\u021bin un factor de risc cardiovascular. Avertismentul a fost extins la \u00eentreaga clas\u0103 de inhibitori JAK. Recomandarea actual\u0103 FDA: rezerva\u021bi inhibitorii JAK pentru pacien\u021bii care au e\u0219uat sau nu pot utiliza un inhibitor TNF mai \u00eent\u00e2i.<\/p>\n<h3 class=\"wp-block-heading\">Este Tofe sigur pe termen lung?<\/h3>\n<p>Datele pe termen lung (p\u00e2n\u0103 la 9,5 ani de tofacitinib) arat\u0103 c\u0103 ratele de evenimente cardiovasculare \u0219i de malignitate la pacien\u021bii cu risc standard r\u0103m\u00e2n apropiate de ratele din popula\u021bia general\u0103. Semnalul din studiul ORAL Surveillance este concentrat la pacien\u021bii \u00een v\u00e2rst\u0103 cu factori de risc cardiovascular preexisten\u021bi. La pacien\u021bii tineri \u0219i s\u0103n\u0103to\u0219i cu AR, tofacitinibul pe termen lung este o op\u021biune rezonabil\u0103 \u2014 dar verific\u0103ri anuale ale pielii, monitorizarea lipidelor, hemograma complet\u0103 \u0219i evaluarea vaccin\u0103rii r\u0103m\u00e2n esen\u021biale.<\/p>\n<h3 class=\"wp-block-heading\">Pot face herpes zoster (zona) din cauza lui Tofe?<\/h3>\n<p>Reactivarea varicellei-zoster latente (zona) este semnificativ mai frecvent\u0103 la pacien\u021bii trata\u021bi cu inhibitori de JAK dec\u00e2t la cei trata\u021bi cu TNFi sau \u00een popula\u021bia general\u0103 \u2014 rate de 2\u20135 ori mai mari, cu pacien\u021bii asiatici av\u00e2nd cel mai mare risc. Dac\u0103 ave\u021bi peste 50 de ani sau sunte\u021bi imunocompromis, face\u021bi vaccinul recombinant \u00eempotriva zonei (Shingrix, dou\u0103 doze) cu cel pu\u021bin 4 s\u0103pt\u0103m\u00e2ni \u00eenainte de a \u00eencepe Tofe. Vaccinul live-attenuat \u00eempotriva zonei (Zostavax) este contraindicated \u00een terapia cu JAK.<\/p>\n<h3 class=\"wp-block-heading\">Poate fi Tofe combinat cu metotrexat?<\/h3>\n<p>Da \u2014 metotrexatul este DMARD-ul standard de baz\u0103 utilizat \u00eempreun\u0103 cu tofacitinibul \u00een artrita reumatoid\u0103, iar terapia combinat\u0103 produce rezultate mai bune dec\u00e2t tofacitinibul singur \u00een majoritatea studiilor. Nu exist\u0103 interac\u021biune farmacocinetic\u0103. Monitoriza\u021bi hemoleucograma \u0219i testele hepatice \u00een mod regulat la ambele medicamente. Inhibitorii JAK trebuie <strong>prime\u0219te,<\/strong> poate fi combinat cu DMARD-uri biologice (TNFi, IL-6i, rituximab, abatacept) \u2014 riscul de infec\u021bie este inacceptabil.<\/p>\n<h3 class=\"wp-block-heading\">Ce se \u00eent\u00e2mpl\u0103 cu sarcina \u0219i al\u0103ptarea?<\/h3>\n<p>Tofacitinibul este <strong>nerecomandat\u0103<\/strong> \u00een timpul sarcinii \u2014 datele animale arat\u0103 teratogenitate scheletic\u0103 \u0219i visceral\u0103, iar datele umane sunt insuficiente. Folosi\u021bi metode contraceptive eficiente \u00een timpul tratamentului \u0219i pentru cel pu\u021bin o s\u0103pt\u0103m\u00e2n\u0103 dup\u0103 ultima doz\u0103. Nu utiliza\u021bi \u00een timpul al\u0103pt\u0103rii \u2014 se a\u0219teapt\u0103 ca tofacitinibul s\u0103 treac\u0103 \u00een laptele matern \u0219i s\u0103 afecteze copilul. Planifica\u021bi sarcina \u00een discu\u021bie cu reumatologul dumneavoastr\u0103 \u2014 trece\u021bi la un DMARD compatibil cu sarcina (hidroxiclorochina, certolizumab, sulfasalazina) \u00eenainte de concep\u021bie.<\/p>\n<h3 class=\"wp-block-heading\">Ar trebui s\u0103 \u00eentrerup Tofe dac\u0103 r\u0103cesc sau iau grip\u0103?<\/h3>\n<p>Pentru infec\u021bii u\u0219oare ale tractului respirator superior f\u0103r\u0103 febr\u0103, continua\u021bi medicamentul \u0219i monitoriza\u021bi. Pentru orice altceva mai grav \u2014 febr\u0103 \u2265 38\u00b0C, tuse productiv\u0103, simptome de pielonefrit\u0103, celulit\u0103, reactivare de herpes zoster, suspiciune de pneumonie sau COVID-19 care necesit\u0103 tratament \u2014 \u00eentrerupe\u021bi imediat Tofe \u0219i contacta\u021bi medicul prescriptor. Relua\u021bi tratamentul doar dup\u0103 ce infec\u021bia s-a rezolvat complet. Aceast\u0103 regul\u0103 de \u201cpauz\u0103 \u00een timpul infec\u021biei\u201d este cea mai important\u0103 abilitate de autogestionare \u00een terapia cu JAK.<\/p>\n<h3 class=\"wp-block-heading\">Ce teste de laborator am nevoie \u0219i c\u00e2t de des?<\/h3>\n<p>Monitorizarea standard dup\u0103 \u00eenceperea Tofe: <strong>Hemogram\u0103 cu formula \u0219i teste hepatice (LFTs) la s\u0103pt\u0103m\u00e2nile 4, 8, 12, apoi la fiecare 3 luni.<\/strong> <strong>Profil lipidic la s\u0103pt\u0103m\u00e2na 8, apoi anual.<\/strong> <strong>Func\u021bia renal\u0103 la fiecare 3\u20136 luni.<\/strong> Este recomandat un control dermatologic anual la pacien\u021bii cu piele deschis\u0103 la culoare, cu antecedente de cancer de piele sau dup\u0103 12 luni de terapie. O sc\u0103dere a limfocitelor sub 0,5 \u00d7 10&amp;sup9;\/L, a neutrofilor sub 1,0 sau o cre\u0219tere a ALT peste de 3 ori limita superioar\u0103 normal\u0103 necesit\u0103 \u00eentreruperea tratamentului p\u00e2n\u0103 la revenirea parametrilor.<\/p>\n<h3 class=\"wp-block-heading\">De ce s\u0103 comanzi de la MedsBase<\/h3>\n<p>Tofe este furnizat printr-un produc\u0103tor certificat WHO-GMP cu documenta\u021bie COA complet\u0103. Expediem \u00een \u00eentreaga lume \u00een ambalaje discrete \u0219i simple, iar fiecare comand\u0103 este acoperit\u0103 de <a href=\"\/ro\/medsbase-re-shipment-assurance-policy\/\">Politica noastr\u0103 de Reexpediere Garantat\u0103<\/a>. Descrierea tranzac\u021biei la plata cu cardul afi\u0219eaz\u0103 procesatorul de pl\u0103\u021bi reglementat (un procesator de pl\u0103\u021bi cu card reglementat), niciodat\u0103 \u201cMedsBase\u201d sau nume de medicamente.<\/p>\n<p><!-- medsbase-related-alts-v1 --><\/p>\n<h3 class=\"wp-block-heading\">Alte Medicamente Antiinflamatoare \u0219i Autoimune<\/h3>\n<p>Dac\u0103 Tofe nu se potrive\u0219te situa\u021biei dumneavoastr\u0103, urm\u0103toarele op\u021biuni sunt disponibile \u00een aceast\u0103 categorie:<\/p>\n<ul>\n<li><a href=\"https:\/\/medsbase.com\/ro\/barinat\/\">Barinat (Baricitinib 2\/4 mg, Cipla) \u2014 inhibitor selectiv de JAK1\/JAK2<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/wysolone\/\">Wysolone (Prednisolon 5\/10\/20 mg, Wyeth) \u2014 corticosteroid de punte pentru puseuri<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/kenacort\/\">Kenacort (Triamcinolon 4 mg, Abbott) \u2014 corticosteroid oral<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/azoran\/\">Azoran (Azathioprine 50 mg, RPG) \u2014 antimetabolit de purin\u0103<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/conimune-me\/\">Conimune ME (Ciclosporin\u0103 25\/50\/100 mg) \u2014 inhibitor al calcineurinei<\/a><\/li>\n<\/ul>","protected":false},"excerpt":{"rendered":"<p>\u2705 Reduce inflama\u021bia articular\u0103<br \/>\n\u2705 \u00cembun\u0103t\u0103\u021be\u0219te func\u021bia fizic\u0103<br \/>\n\u2705 Amelioreaz\u0103 durerea reumatoid\u0103<br \/>\n\u2705 \u00cencetine\u0219te progresia bolii<br \/>\n\u2705 Spor\u0219e\u0219te mobilitatea zilnic\u0103<\/p>\n<p><strong>Tofe<\/strong> con\u021bine <strong>Tofacitinib<\/strong> 5 mg.<\/p>","protected":false},"featured_media":66708,"comment_status":"open","ping_status":"closed","template":"","meta":[],"product_brand":[],"product_cat":[3897,3141,3223],"product_tag":[5359,5358],"class_list":{"0":"post-66707","1":"product","2":"type-product","3":"status-publish","4":"has-post-thumbnail","6":"product_cat-anti-inflammatory-autoimmune-care","7":"product_cat-category-overview","8":"product_cat-chronic-conditions","9":"product_tag-tofacitinib","10":"product_tag-tofe","12":"first","13":"instock","14":"shipping-taxable","15":"purchasable","16":"product-type-variable","17":"has-default-attributes"},"acf":[],"_links":{"self":[{"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product\/66707","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product"}],"about":[{"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/types\/product"}],"replies":[{"embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/comments?post=66707"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/media\/66708"}],"wp:attachment":[{"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/media?parent=66707"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product_brand?post=66707"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product_cat?post=66707"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product_tag?post=66707"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}