Tofacitinib Versus Biologic Treatments in Patients with Active Rheumatoid Arthritis who have had an Inadequate Response to Tumor Necrosis Factor Inhibitors: Results from a Network Meta-Analysis
Clin Ther 2016;38:2628–40.
This network meta-analysis, performed within a Bayesian framework, concluded that tofacitinib 5 mg BID has efficacy and AE rates comparable with currently available bDMARDs over a 24-week period in patients experiencing an inadequate response to TNF therapy. A systematic literature search identified five, Phase 2 or beyond, randomised controlled trials for inclusion in the analysis. Each trial had an adult population with moderate to severe RA, with inadequate response (IR) or failed treatment with TNF inhibitor(s), and treatment with the following bDMARDs: abatacept, adalimumab, anakinra, etanercept, golimumab, infliximab, rituximab and tocilizumab.Tofacitinib BID was more efficacious compared with placebo, and comparable to bDMARDs with respect to ACR response rates at Weeks 12 and 24. Consistent with data at Week 12, at Week 24 HAQ-DI change from baseline was greater with tofacitinib than placebo, and was comparable to other interventions. Withdrawal due to all causes or AEs was similar for tofacitinib, bDMARDs and placebo; tofacitinib was associated with reduced withdrawals due to efficacy.Despite the limitations of this analysis, for example the variation in the definition of TNF-IR, and the small number of studies included, in the absence of head to head comparisons of bDMARDs with tofacitinib, this analysis provides support for the use of tofacitinib as a well-tolerated, effective therapy for patients with moderate to high disease activity who have failed ≥1 bDMARD.
