Study shows comparable effectiveness of tofacitinib and adalimumab in treating axial spondylarthritis

Findings from a real-world multicenter study, published in the Journal of Clinical Rheumatology, revealed that tofacitinib has comparable effectiveness to adalimumab in managing axial spondyloarthritis (AxSpA) patients. 

Goswami and colleagues evaluated adult patients diagnosed with AxSpA, who were administered either tofacitinib at a dosage of 5 milligrams twice daily or adalimumab at 40 milligrams subcutaneously every two weeks. Out of the 266 patients enrolled, 135 received tofacitinib while 131 were treated with adalimumab, with a follow-up duration of 6.5 ± 1.6 months. The mean improvement in Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) (3.39 ± 0.09 vs. 3.14 ± 1.16, respectively) and Ankylosing Spondylitis Disease Activity Score (ASDAS) (1.78 ± 0.68 vs. 2.07 ± 2.08, respectively) demonstrated comparability between the two cohorts.  

Notably, a greater proportion of patients achieved a BASDAI50 response in the second and fourth month, as well as ASDAS low disease activity in the fourth month in the adalimumab group. However, by the sixth month, all disease activity measurements were similar between both groups. Interestingly, a higher percentage of patients in the tofacitinib cohort required a change in therapy compared to those in the adalimumab cohort. The incremental cost-effectiveness ratio for adalimumab versus tofacitinib was calculated at US $188.8 per patient in the adalimumab group for each person-month with BASDAI <4. 

Several studies have previously investigated the comparative effectiveness of tofacitinib and adalimumab in treating inflammatory arthritis. Among these, the ORAL-Standard trial conducted by Van et al. focused on rheumatoid arthritis (RA) patients, the ORAL-Strategy study led by Fleischmann et al. involved a head-to-head comparison in RA patients, and the OPAL-Broaden study by Mease et al. focused on patients with Psoriatic Arthritis. Across these studies, tofacitinib consistently demonstrated comparable efficacy to adalimumab. 

While adalimumab has shown a quicker and sustained response with a lower likelihood of treatment switching, it also comes with a significantly higher financial burden for patients. Tofacitinib, on the other hand, emerges as a viable short-term alternative, particularly for AxSpA patients facing financial constraints with regular adalimumab therapy. Although conclusive evidence regarding tofacitinib’s precise role remains elusive, its potential as an alternative treatment option cannot be overlooked. Future research should prioritize optimizing treatment strategies for AxSpA and exploring the economic implications and patient-reported outcomes of therapies. 

For in-depth insights into tofacitinib and adalimumab, please follow the expert talk published in RheumaTV: 

https://rheumatv.com/use-of-tofacitinib-in-ankylosing-spondylitis-by-dr-chandrashekara-s/ 

https://rheumatv.com/tofacitinib_indications-its-use-in-rheumatolgy-by-dr-raj-kiran-hyderabad/ 

https://rheumatv.com/adalimumab/ 

References 

  1. Goswami RP, Sinha D, Chatterjee M, Bhadu D, Das S. Comparative Effectiveness of Tofacitinib and Adalimumab in Axial Spondyloarthritis: A Real-World Clinical Context Multicenter Study. J Clin Rheumatol. 2024 Mar 2.
  2. Fleischmann R, Mysler E, Hall S, Kivitz AJ, Moots RJ, Luo Z, et al. Efficacy and safety of tofacitinib monotherapy, tofacitinib with methotrexate, and adalimumab with methotrexate in patients with rheumatoid arthritis (ORAL Strategy): a phase 3b/4, double-blind, head-to-head, randomised controlled trial. Lancet. 2017 Jul 29;390(10093):457–68.  
  3. Mease P, Hall S, FitzGerald O, van der Heijde D, Merola JF, Avila-Zapata F, et al. Tofacitinib or Adalimumab versus Placebo for Psoriatic Arthritis. N Engl J Med. 2017 Oct 19;377(16):1537–50.  
  4. Van Vollenhoven RF, Fleischmann R, Cohen S, Lee EB, García Meijide JA, Wagner S, et al. Tofacitinib or adalimumab versus placebo in rheumatoid arthritis. N Engl J Med. 2012 Aug 9;367(6):508–19.  

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