Physicians and Patients With RA Report Similar Effectiveness Outcomes With Tofacitinib vs TNFi Therapy

RA in hand
Rheumatoid arthritis. General practitioner examining a patient’s hand for signs of rheumatoid arthritis. This condition is caused by the immune system attacking the body’s own tissues, causing progressive joint and cartilage destruction. As the cartilage is worn away, new bone grows as part of the repair process. This causes stiffness and deformity of the fingers. Treatment is with anti-inflammatory drugs and physiotherapy.
Researchers assessed physician and patient-reported effectiveness outcomes of treatment with tofacitinib vs tumor necrosis factor inhibitors, using real-world data from the Ontario Best Practices Research Initiative (OBRI).

Physicians and patients with rheumatoid arthritis (RA) reported similar effectiveness outcomes with tofacitinib vs tumor necrosis factor inhibitors (TNFis) 6 months after treatment, according to study results published in The Journal of Rheumatology.

Janus kinase inhibitor tofacitinib has been approved for use in patients with RA as an alternative to biologic disease-modifying antirheumatic drugs (bDMARDs), such as TNFis. Although the safety and efficacy of tofacitinib has been demonstrated in randomized controlled trials, real-world data of its efficacy compared with bDMARDs are limited. 

To examine physician and patient-reported outcomes with TNFi vs tofacitinib treatment, researchers used the Ontario Best Practices Research Initiative (OBRI), which includes data from rheumatologists and patients with RA across Ontario, Canada.

Patient data included general medical history, Health Assessment Questionnaire-Disability Index (HAQ-DI), global assessment, and RA disease activity index (RADAI). Rheumatologists reported patient history of previous comorbidities, including cardiovascular disease (CVD), RA disease activity, inflammatory markers, tender, swollen joint counts, and clinical disease activity index (CDAI) low disease activity (LDA) scores. Sociodemographic data, smoking status, height and weight, and any prior and current medications were also recorded.

In the current analysis, patients who were initiated with treatment with tofacitinib or TNFis between June 2014 and December 2019 were included. Of the 419 patients who met the inclusion criteria, 226 received TNFi and 193 received tofacitinib.

At baseline, patients who received treatment with tofacitinib vs TNFi had longer mean disease duration (12.6 vs 8.0 years; P <.001), were more likely to have prior biologic use (78.3% vs 32.1%; P <.001), and used concomitant steroids (26.4% vs 15.5%; P =.006). Patients receiving tofacitinib also reported worse physical function (HAQ-DI, 1.4 vs 1.2; P =.02), more sleep problems (4.8 vs 4.1; P =.05), and a higher prevalence of CVD (11.4% vs 5.8%; P =.03). 

The physician-reported effectiveness outcomes demonstrated higher remission rate in the TNFi vs tofacitinib group (29.2% vs 20.2%). The percentage of patients in CDAI LDA/remission at 6 months was 36.7% and 33.2% in TNFi and tofacitinib groups, respectively. CDAI remission was reported in 10.6% of the TNFi group and 6.7% of the tofacitinib group.  

For patient-reported effectiveness outcomes, no significant difference in the mean change at 6 months was found in HAQ-DI scores with TNFi vs tofacitinib (-0.10 vs -0.06; P >.05) and RADAI scores (-0.63 vs -0.75; P =.71). In addition, no significant changes were seen in changes in fatigue, global pain, current disease activity, prior disease activity, painful joint count, morning stiffness, sleep problems, and depression. All results were nonsignificant and similar to findings from previous reported data, suggesting similar efficacy between tofacitinib and TNFi use.

Study limitations included the potential bias in estimation due to unmeasured or residual confounders, which may be related to study design or registry data collection methods, and the differences in practice patterns of physicians enrolled in OBRI.

“To the best of our knowledge, this study may be one of the first real-world studies to thoroughly compare patient reported effectiveness outcomes in TNFi and [tofacitinib] users in [patients with] RA including those with prior exposure to biologic therapy,” the researchers noted.

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


Movahedi M, Cesta A, Li X, Keystone EC, Bombadier C; OBRI Investigators. Physician and patient reported effectiveness are similar for tofacitinib and TNFi in rheumatoid arthritis: data from a rheumatoid arthritis registry. J Rheum. Published online February 15, 2022. doi:10.3899/jrheum.211066