The study concluded that tofacitinib drug maintenance was comparable with bDMARDs-OMA and somewhat higher than TNFi. Concomitant csDMARDs appear to be required for optimal effectiveness of TNFi, but not for bDMARD-OMA or Tofa.

• Adjusted analyses demonstrated a higher risk of drug discontinuation with TNFis than with XELJANZ (HR: 1.29 [95% CI: 1.14–1.47])
• No significant difference in drug discontinuation was observed between b/tsDMARDs-OMA and XELJANZ (HR: 1.09 [95% CI: 0.96–1.24])
• LDA at Month 12 was achieved in 40% of those receiving TNFi, 46% receiving b/tsDMARD-OMA and 40% receiving XELJANZ. The likelihood of reaching LDA at Month 12 was not significantly different between the three treatments

IMage adapted from Finckh A, et al. 2020.
§Note: the XELJANZ monotherapy and combination therapy lines are overlapping

• Drug maintenance with XELJANZ or bDMARD-OMA was not significantly different with or without csDMARDs, whereas TNFi drug maintenance significantly improved with concomitant csDMARD therapy
• The likelihood of reaching LDA with XELJANZ, bDMARD-OMA, or TNFi with or without csDMARDs was similar

†bDMARD-OMA agents were abatacept and anti-IL-6 receptor (tocilizumab or sarilumab).
‡The adjusted survival curves based on 4023 treatment courses with 2103 events, representing the average patient in the SCQM population: female, seropositive, non-smoking patients with one prior bDMARD, mean age of 57, disease duration of 10.5 years, baseline DAS28 of 3.7, BMI of 26, who initiated treatment before the launch of a second JAKi.

OR=odds ratio; HR=hazard ratio; bDMARD=biologic disease-modifying anti-rheumatic drug; CDAI=Clinical Disease Activity Index;
csDMARD=conventional synthetic disease‑modifying anti-rheumatic drug; MTX=methotrexate;
OMA=other modes of action; TNFi=tumour necrosis factor inhibitor; tsDMARD=targeted synthetic
disease-modifying anti-rheumatic drug

References