Tofacitinib vs Baricitinib Compared for the Treatment of Rheumatoid Arthritis in Clinical Practice

Baricitinib may be more appropriate than tofacitinib in the treatment of patients with rheumatoid arthritis (RA) with treatment-resistance to many biologic disease-modifying antirheumatic drugs (bDMARDs), according to study data presented at the European Alliance of Associations for Rheumatology (EULAR) 2021 Virtual Congress, held between June 2 and 5, 2021.

The comparison of efficacies of Janus kinas (JAK) inhibitors baricitinib and tofacitinib have not been closely examined in clinical practice.

Researchers conducted a retrospective observational study of patients with RA who received treatment with tofacitinib (n=156) or baricitinib (n=138). The primary outcome was reduction in Clinical Disease Activity Index (CDAI) after 24 weeks of treatment. The percentage of patients in remission according to CDAI was also included in the analysis. Trajectories of change in CDAI were assessed using growth mixture modeling. Correlates of treatment resistance were identified using multivariable logistic regression models. Selection bias was minimized using propensity score-based inverse probability of treatment weighting.

Baseline clinical and demographic characteristics were comparable between the 2 groups. At week 24, mean CDAI was significantly lower in the baricitinib group compared with the tofacitinib group (6.2±7.2 vs 8.0±8.9, respectively; P =.02). Patients receiving baricitinib vs tofacitinib were also significantly more likely to be in CDAI remission at week 24 (odds ratio [OR], 1.7; 95% CI, 1.1-2.7; P =.04).

According to growth mixture modeling, disease activity improved in the majority of patients after the introduction of the JAK inhibitors. Patients who did not achieve low disease activity by week 24 were classified as resistant to treatment. Baseline factors associated with treatment-resistance included high baseline Health Assessment Questionnaire-Disability Index (OR, 1.76; 95% CI, 1.09-2.84; P =.02) and a high number of bDMARDs used before the JAK inhibitors (OR, 1.51; 95% CI, 1.16-1.95; P =.002). Patients who received tofacitinib vs baricitinib were more likely to be classified as treatment-resistant (OR, 2.13; 95% CI, 1.05-4.30; P =.03). In the tofacitinib group, patients who had received 4 or more bDMARDs vs those who received less than 4 bDMARDs before the introduction of the JAK inhibitor were more likely to be classified into the treatment-resistant group (OR, 1.76; 95% CI, 1.24-4.06). In the baricitinib group, no significant risk factors for treatment-resistance were identified.

According to these data, both the JAK inhibitors displayed efficacy in the treatment of RA, though baricitinib was associated with higher rates of remission and greater reductions in CDAI. Baricitinib also appeared to be more appropriate for patients without a response to prior treatment with bDMARDs.

“[T]he present study suggests that [baricitinib] may be more appropriate for patients [with RA] resistant to many bDMARDs,” the researchers wrote.

Disclosure: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures. 

Reference

Miyazaki Y, Nakayamada S, Nakano K, et al. Comparison of tofacitinib and baricitinib by inverse probability of treatment weighting analyses based on propensity score in patients with rheumatoid arthritis in real clinical practice. Presented at: EULAR 2021 Virtual Congress; June 2-5, 2021. Poster #POS0221.