How Does Tofacitinib Compare With Biologics for RA?

Tofacitinib is safe and effective compared with biologic therapies for the treatment of rheumatoid arthritis (RA) among patients who were previously treated with methotrexate, according to new study findings.

An oral Janus kinase inhibitor, tofacitinib is the first of its kind that is approved to treat RA.
_________________________________________________________________________________

RELATED CONTENT
Treating Rheumatoid Arthritis: What Are Clinicians Overlooking?
Study Details Benefits of Early Treatment for Rheumatoid Arthritis
_________________________________________________________________________________

In a cohort study, researchers evaluated 21,832 patients with RA using 2011-2014 data from MarketScan databases.

All patients included in the study were newly prescribed tofacitinib, disease-modifying antirheumatic drugs (DMARDs) other than methotrexate, and biologics. Patients treated with non-tumor necrosis factor (non-TNF) treatment served as controls.

Factors such as high adherence, no biologic or tofacitinib switch or addition, and no DMARD switch or addition determined therapy effectiveness.

Approximately 0.8% of the cohort was treated with tofacitinib, 24.7% had received other DMARDs, 61.2% were treated with TNF inhibitors, and 13.3% had received non-TNF biologics. Ultimately, the rates of therapy effectiveness were determined to be 15.4% for tofacitinib, 11.1% for DMARDs, 18.6% for TNF inhibitors, and 19.8% for non-TNF biologics.

In adjusted analyses, the effectiveness rates of tofacitinib and non-TNF biologics were similar, whereas DMARD initiators were less effective compared with non-TNF biologics.

The researchers noted that they could not establish whether tofacitinib resulted in a higher rate of serious infections.

“In summary, in this report of a large population-based cohort study, we present novel data on real-world use of tofacitinib in patients with RA previously treated with methotrexate,” the researchers concluded.

“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.”

—Christina Vogt

Reference:

de Ávila Machado MA, de 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;20:60. https://doi.org/10.1186/s13075-018-1539-6.