medwireNews: Findings from a rheumatoid arthritis (RA) registry study suggest that the Janus kinase (JAK) inhibitor tofacitinib may have comparable real-world effectiveness to tumor necrosis factor (TNF) inhibitors.
These results follow reports from the ORAL Surveillance trial, which showed that tofacitinib is associated with higher rates of major adverse cardiovascular events and malignancy than TNF inhibitors in RA patients at high cardiovascular risk.
For the registry study, Claire Bombardier (University of Toronto, Ontario, Canada) and team evaluated data from 419 RA patients with at least one swollen joint who initiated tofacitinib (n=193) or a TNF inhibitor (n=226) between 2014 and 2019 and were included in the Ontario Best Practices Research Initiative. The mean disease duration in the two groups was 12.6 and 8.0 years, respectively, and rates of prior biologic use were a corresponding 67.9% and 21.7%.
At the 6-month follow-up, the proportion of patients with low disease activity (LDA) or remission (CDAI ≤10) was comparable in the tofacitinib and TNF inhibitor groups, at 33.2% and 36.7%, respectively. Rates of remission according to a CDAI score of 2.8 or lower (6.7 vs 10.6%) and LDA or remission according to DAS28-ESR of 3.2 or lower (35.8 vs 40.7%) were also comparable, but rates of remission as defined by DAS28-ESR of 2.6 or lower were significantly reduced among patients on the JAK inhibitor (20.2 vs 29.2%).
Nonetheless, in propensity score-adjusted models that adjusted for differences in baseline characteristics that may have influenced treatment choice, there were no significant differences in any of these measures between the two groups.
The researchers also found no significant between-group differences in patient-reported outcomes with tofacitinib versus TNF inhibitor treatment. For instance, the average HAQ-DI score decreased by 0.06 points in the tofacitinib group and 0.10 points in the TNF inhibitor group from baseline to month 6, while Rheumatoid Arthritis Disease Activity Index (RADAI) scores decreased by 0.63 and 0.75 points, respectively. The average baseline measures in the overall study population were 1.3 points for HAQ-DI and 3.9 points for RADAI.
Taken together, the study results indicate that “physician and patient-reported effectiveness are similar” with tofacitinib and TNF inhibitors, write Bombardier et al in The Journal of Rheumatology.
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