Risk of venous thromboembolism with tofacitinib versus tumor necrosis factor inhibitors in cardiovascular risk-enriched rheumatoid arthritis patients

Arthritis Rheumatol 2024 doi: 10.1002/art.42846 Epub ahead of print https://pubmed.ncbi.nlm.nih.gov/38481002/

This post hoc analysis of ORAL Surveillance showed that incidence of venous thromboembolism (VTE) events was higher in patients with RA treated with tofacitinib (10>5mg BID) versus TNFi. Across treatments, VTE risk factors (age, BMI, and VTE history) were aligned with previous studies in the general RA population.

Unadjusted time to all-cause discontinuation was significantly longer with baricitinib treatment versus TNFi (estimated median prescription survival time of 704 days versus 448 days; log-rank P<0.01). This difference increased when only comparing differences for b/tsDMARD-naïve patients treated with baricitinib versus tofacitinib.

February 2024

Guselkumab treatment exhibited generally comparable and significant pharmacodynamic effects on IL-23/Th17–associated cytokines across participants with PsA who are biologic-naïve or have TNFi-IR. In coming to this conclusion, investigators assessed and compared immunologic differences and associations with clinical response to guselkumab in participants with active PsA who were biologic-naïve or TNFi-IR.

Bimekizumab was well tolerated in patients with PsA and TNFi-IR up to 52 weeks, with a safety profile consistent with that observed in prior studies. This study aimed to assess 52-week safety and efficacy of bimekizumab in patients with active PsA and prior IR/intolerance to TNFi.

This study by Cho, et al. did not find any significant differences in remission rates in South Korean patients with RA that were treated with tofacitinib versus TNFi in a real-world setting. Remission rates were significantly higher for patients naïve to both JAKi and bDMARDs treated with tofacitinib versus TNFi.

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January 2024

This post hoc analysis by Curtis, et al. found that current and former smokers were more likely to switch from an anti-TNF bDMARD to a different bDMARD or JAK inhibitor in comparison to non-smokers. They also found that DAS28(CRP) ≤3.2 achievement was significantly higher after filgotinib therapy regardless of smoking status in MTX-IR, bDMARD-IR, and MTX-naïve patients.

Nationwide study involving 14 778 new users of targeted therapies with PsA found treatment persistence to be lower for women than men for TNFi and IL17i but not for IL-12/23i, IL-23i or JAK inhibition.

Kwon, et al. found that adalimumab exposure significantly reduced risk of incident and recurrent acute anterior uveitis (AAU) versus etanercept exposure and bDMARD non-exposure. Furthermore, exposure to etanercept significantly increased risk of incident and recurrent AAU versus bDMARD non-exposure.

December 2023

The results of the meta-analysis show that TNFi, IL-17i, and JAK inhibitor treatments significantly improved sacroiliac joint SPARCC scores in patients with axSpA or AS at Weeks 12–16. However, there were no significant differences in mean improvement between the treatment groups.

Post hoc analysis of ORAL Surveillance data highlights that active disease in RA leads to higher risk of adverse medical events, regardless of medication used.

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