Treatment with tofacitinib 10 mg and treatment with apremilast 30 mg were shown to be the most efficacious interventions for patients with active psoriatic arthritis (PsA), according to the results of a meta-analysis published in Clinical Drug Investigation. Data show that neither therapy was associated with a significant risk for serious adverse events.

The investigators sought to evaluate the relative efficacy and safety of tofacitinib and apremilast at different doses for the treatment of patients with active PsA. They conducted a Bayesian network meta-analysis in which they combined evidence from 8 randomized controlled trials designed to assess the efficacy and safety of tofacitinib 10 mg, tofacitinib 5 mg, apremilast 30 mg, and apremilast 20 mg compared with placebo among individuals with PsA.

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Overall, 8 trails that comprised a total of 3086 patients met study inclusion criteria. Ten pairwise comparisons were involved, which included 6 direct comparisons of 5 interventions. Compared with placebo, all the interventions attained 20% improvement in American College of Rheumatology (ACR20) response. Tofacitinib 10 mg and apremilast 30 mg were among the most effective therapies for patients with active PsA, followed by tofacitinib 5 mg and apremilast 20 mg.

The ranking probability according to the surface under the cumulative ranking curve (SUCRA) demonstrated that tofacitinib 10 mg had the highest probability of being the best treatment in terms of ACR20 response rate (SUCRA=0.785). The ranking probability for the remaining treatments were as follows: apremilast 30 mg (SUCRA=0.670), tofacitinib 5 mg (SUCRA=0.596), apremilast 20 mg (SUCRA=0.448), and placebo (SUCRA=0.001).

No significant differences were observed in the incidence of serious adverse events after treatment with tofacitinib 10 mg, apremilast 30 mg, tofacitinib 5 mg, apremilast 20 mg, or placebo.

The investigators concluded that long-term studies are warranted to determine the relative efficacy and safety of tofacitinib and apremilast in a large number of patients with active PsA.

Reference

Song GG, Lee YH. Comparison of the efficacy and safety of tofacitinib and apremilast in patients with active psoriatic arthritis: a Bayesian network meta-analysis of randomized controlled trials [published February 26, 2019]. Clin Drug Investig. doi: 10.1007/s40261-019-00765-w