Comparative effectiveness of tofacitinib, biologic drugs and traditional disease-modifying antirheumatic drugs in rheumatoid arthritis

Background: Most rheumatoid arthritis (RA) patients initiate therapy with methotrexate (MTX), but only 1/3 will have low disease activity with this agent alone. Several therapeutic options are available for patients with MTX-resistant RA, including new Janus kinase (JAK) inhibitors (eg.: tofacitinib). Objectives: To compare the effectiveness of traditional disease-modifying antirheumatic drugs (DMARDs), biologic DMARDs and tofacitinib for RA patients with inadequate response to MTX. Methods: We used MarketScan® databases (2011-2014) to study adult RA individuals previously treated with methotrexate (oral or SQ) and newly prescribed one of the medications under study. The date of first filled prescription or infusion drug was defined as the cohort entry and a 12-month pre-period was used to exclude prior users of biologics or tofacitinib. We required subjects to be continuously enrolled in the medical and pharmacy plan 12 months before and after the cohort entry. Effectiveness was access through an algorithm previously validated1, based on the following criteria: 1) non-adherence; 2) switching/adding a new biologic or tofacitinib; 3) switching/adding a new DMARD; 4) increasing of the dose of the starting therapy; 5) use of glucocorticoid joint injections; and 6) increasing the dose of oral glucocorticoid. A patient's therapy was defined as not effective if at least one of the criterion occurred during the first year of follow-up. Results: 16,305 RA patients were included; 2,879 began therapy with DMARD, 13,345 with biologics and 81 with tofacitinib. Among all patients, 77.5% were female and the mean age was 56.2 years (standard deviation 12.6). Table 1 shows the proportion of patients that meet the individual criterion and that achieved effectiveness at the end of one-year follow-up. Conclusions: Similar rates of therapy effectiveness were observed among groups, although the rates for the individual criteria differed. Fewer patients initiating biologic agents were non-adherent compared to DMARD and tofacitinib therapy, but switch/adding and injections tended to be higher in this group. (Table Presented).