Comparative Effectiveness of Tofacitinib, TNFi, Other Biologics in RA Previously Treated With MTX
Tofacitinib is the first oral Janus kinase inhibitor for the treatment of rheumatoid arthritis. Credit: ISM/SOVEREIGN
No differences were demonstrated in hospitalized infections or effectiveness in patients with rheumatoid arthritis (RA) who previously received treatment with methotrexate and who initiated treatment with tofacitinib or non-tumor necrosis factor (TNF) biologics, according to a retrospective cohort study published in Arthritis Research & Therapy.
Tofacitinib is the first oral Janus kinase inhibitor for the treatment of RA that was approved in the United States, in 2012. To provide direct comparative evidence for the effectiveness of tofacitinib and to expand the safety literature, researchers used data from 2011 to 2014 to compare 21,832 methotrexate-exposed patients with RA who were newly prescribed tofacitinib (0.8%) with those who were prescribed disease-modifying antirheumatic drugs (DMARDs) other than methotrexate (24.7%), TNF inhibitors (61.2%), and non-TNF biologics (13.3%).
At 1 year of follow-up, the researchers found that the rates of therapy effectiveness were 15.4% for tofacitinib, 11.1% for DMARDs, 18.6% for TNF inhibitors, and 19.8% for non-TNF biologics. An adjusted analysis demonstrated that patients using tofacitinib and non-TNF biologic users had similar effectiveness rates, and DMARDs were less effective than non-TNF biologics. However, the unadjusted incidence of hospitalizations for infection was 3.6 per 100 patient-years for tofacitinib compared with 2.2 and 2.5 per 100 patient-years in patients taking TNF inhibitors and non-TNF biologics, respectively.
"Our study estimated similar (relatively low) effectiveness rates at 1 year of follow-up for patients starting tofacitinib after therapy with methotrexate, as opposed to initiators of non-TNF biologics. Our comparisons of tofacitinib versus non-TNF biologics, though not definitive, did not clearly demonstrate differences with respect to hospitalized infections," the researchers concluded.
Machado MAÁ, Moura CS, Guerra SF, Curtis JR, Abrahamowicz M, Bernatsky S. Effectiveness and safety of tofacitinib in rheumatoid arthritis: a cohort study. Arthritis Res Ther. 2018; 20(1):60.