Tofacitinib is non-inferior to adalimumab in the treatment of rheumatoid arthritis

In a randomized controlled trial published in JAMA Network Open, it was found that the effectiveness of tofacitinib is comparable to adalimumab for treating rheumatoid arthritis (RA). Both medications demonstrated clinically significant reductions in the mean disease activity score in 28 joints using C-reactive protein (DAS28-CRP) after three months of treatment, indicating a positive response and consistency in achieving remission.

Dr. Deakin and colleagues conducted a study that encompassed 842 adult patients with RA from the optimizing patient outcomes in the Australian rheumatology (OPAL) data set. These participants were newly initiated on either biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs). Out of the total participants, 569 patients received adalimumab, while 273 were prescribed tofacitinib. The researchers noted that after a three-month period, participants who received tofacitinib exhibited a slight but statistically significant reduction in the mean DAS28-CRP compared to those who were administered adalimumab [2.4 (95% CI, 2.2-2.5) versus 2.6 (95% CI, 2.5-2.7)]. However, at nine months, there was no discernible difference between the two treatment groups [2.3 (95% CI, 2.1-2.4) versus 2.3 (95% CI, 2.2-2.4)].

The current study findings are in line with previous research findings, specifically a clinical trial conducted by Fleischmann et al. This study demonstrated that in RA patients with inadequate response to methotrexate, combination therapy involving tofacitinib and methotrexate was as effective as adalimumab and methotrexate combination. The results of the present study further support the 2019 European Alliance of Associations for Rheumatology (EULAR) guidelines, which consider Janus kinase inhibitors bDMARDs to have equal efficacy as first-line treatment options.

The recent study findings indicate that tofacitinib demonstrates comparable efficacy to adalimumab in the treatment of rheumatoid arthritis (RA), thus highlighting the potential of tofacitinib as a viable alternative treatment option. However, further studies are necessary to better understand the risk factors and safety profiles associated with both medications, as this information is crucial for informed clinical decision-making. 

References

  1. Deakin CT, De Stavola BL, Littlejohn G, Griffiths H, Ciciriello S, Youssef P, et al. Comparative Effectiveness of Adalimumab vs Tofacitinib in Patients with Rheumatoid Arthritis in Australia. JAMA Netw Open. 2023 Jun 1;6(6):e2320851. 
  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):457-468.
  3. Smolen JS, Landewé RBM, Bijlsma JWJ, Burmester GR, Dougados M, Kerschbaumer A, McInnes IB, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis. 2020 Jun;79(6):685-699. 
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