Is tofacitinib (Shangjie) a hormonal drug and its differences with hormonal therapy?

Tofacitinib is an oral small molecule targeted drug that is a Janus kinase (JAK) inhibitor that selectively inhibits JAK1 and JAK3 Signaling pathway, blocking the signal transduction of various inflammatory factors, thereby exerting anti-inflammatory and immunoregulatory effects. It is mainly used to treat autoimmune diseases such as moderately to severely active rheumatoid arthritis, psoriatic arthritis, and ulcerative colitis. Tofacitinib is not a hormonal drug. Its mechanism of action is completely different from that of glucocorticoids, and it does not directly rely on glucocorticoid receptors to mediate inflammation suppression.

Hormonal drugs (such as prednisone and methylprednisolone) regulate gene expression by binding to intracellular glucocorticoid receptors, quickly inhibiting inflammatory and immune responses, and usually take effect quickly. In contrast, tofacitinib inhibits the production and action of pro-inflammatory cytokines by blocking the JAK-STAT signaling pathway, thereby reducing immune-mediated tissue damage. Although the onset of action is slightly slow, it can target abnormal activation of the immune system and is a targeted immunomodulatory treatment.

In clinical application, tofacitinib has a longer long-term maintenance advantage compared with hormones. Long-term use of hormones may lead to adverse reactions such as osteoporosis, hyperglycemia, obesity, and increased risk of infection. Tofacitinib can avoid these systemic hormone side effects to a certain extent by targeting specific signaling pathways. However, tofacitinib may still cause risks such as elevated blood lipids, infection, and thrombosis, and requires monitoring and dosage adjustment under the guidance of a physician.

In general, tofacitinib (Tofacitinib) is not a hormonal drug, but a small molecule immunomodulator targeting the JAK signaling pathway. It is significantly different from hormone therapy in terms of mechanism of action, onset of action and long-term safety, providing a hormone replacement or combined treatment option for patients with autoimmune diseases. In clinical use, appropriate options must be selected based on the patient's specific condition and risk factors to maximize efficacy and minimize side effects.

Keyword tag:

JAKInhibitors, rheumatoid arthritis, psoriatic arthritis, ulcerative colitis, immune modulation, non-hormonal therapy, side effect management, infection risk, cardiovascular monitoring

Reference materials:https://www.ncbi.nlm.nih.gov/books/NBK572148/