PMID- 28079510
OWN - NLM
STAT- MEDLINE
DCOM- 20170831
LR  - 20181202
IS  - 0392-856X (Print)
IS  - 0392-856X (Linking)
VI  - 35
IP  - 4
DP  - 2017 Jul-Aug
TI  - A comparison of discontinuation rates of tofacitinib and biologic 
      disease-modifying anti-rheumatic drugs in rheumatoid arthritis: a systematic 
      review and Bayesian network meta-analysis.
PG  - 689-699
AB  - OBJECTIVES: The purpose of this study was to compare the discontinuation rates of 
      tofacitinib and biologics (tumour necrosis factor inhibitors (TNFi), abatacept, 
      rituximab, and tocilizumab) in rheumatoid arthritis (RA) patients considering 
      inadequate responses (IRs) to previous treatment(s). METHODS: Randomised 
      controlled trials of tofacitinib and biologics - reporting at least one total 
      discontinuation, discontinuation due to lack of efficacy (LOE), and 
      discontinuation due to adverse events (AEs) - were identified through systematic 
      review. The analyses were conducted for patients with IRs to conventional 
      synthetic disease-modifying anti-rheumatic drugs (cDMARDs) and for patients with 
      biologics-IR, separately. Bayesian network meta-analysis was used to estimate 
      rate ratio (RR) of a biologic relative to tofacitinib with 95% credible interval 
      (CrI), and probability of RR being <1 (P[RR<1]). RESULTS: The analyses of 34 
      studies showed no significant differences in discontinuation rates between 
      tofacitinib and biologics in the cDMARDs-IR group. In the biologics-IR group, 
      however, TNFi (RR 0.17, 95% CrI 0.01-3.61, P[RR<1] 92.0%) and rituximab (RR 0.20, 
      95% CrI 0.01-2.91, P[RR<1] 92.3%) showed significantly lower total 
      discontinuation rates than tofacitinib did. Despite the difference, 
      discontinuation cases owing to LOE and AEs revealed that tofacitinib was 
      comparable to the biologics. CONCLUSIONS: The comparability of discontinuation 
      rate between tofacitinib and biologics was different based on previous treatments 
      and discontinuation reasons: LOE, AEs, and total (due to other reasons). 
      Therefore, those factors need to be considered to decide the optimal treatment 
      strategy.
FAU - Park, Sun-Kyeong
AU  - Park SK
AD  - School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea.
FAU - Lee, Min-Young
AU  - Lee MY
AD  - School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea.
FAU - Jang, Eun-Jin
AU  - Jang EJ
AD  - Department of Information Statistics, Andong National University, 
      Gyeongsangbuk-do, South Korea.
FAU - Kim, Hye-Lin
AU  - Kim HL
AD  - College of Pharmacy, Sahmyook University, Seoul, South Korea.
FAU - Ha, Dong-Mun
AU  - Ha DM
AD  - School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea.
FAU - Lee, Eui-Kyung
AU  - Lee EK
AD  - School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea. 
      ekyung@skku.edu.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20170105
PL  - Italy
TA  - Clin Exp Rheumatol
JT  - Clinical and experimental rheumatology
JID - 8308521
RN  - 0 (Antirheumatic Agents)
RN  - 0 (Biological Products)
RN  - 0 (Piperidines)
RN  - 0 (Protein Kinase Inhibitors)
RN  - 0 (Pyrimidines)
RN  - 0 (Pyrroles)
RN  - 87LA6FU830 (tofacitinib)
SB  - IM
MH  - Antirheumatic Agents/*therapeutic use
MH  - Arthritis, Rheumatoid/*drug therapy
MH  - Bayes Theorem
MH  - Biological Products/*therapeutic use
MH  - *Deprescriptions
MH  - Humans
MH  - Network Meta-Analysis
MH  - Piperidines/*therapeutic use
MH  - Protein Kinase Inhibitors/*therapeutic use
MH  - Pyrimidines/*therapeutic use
MH  - Pyrroles/*therapeutic use
EDAT- 2017/01/13 06:00
MHDA- 2017/09/01 06:00
CRDT- 2017/01/13 06:00
PHST- 2016/08/31 00:00 [received]
PHST- 2016/11/21 00:00 [accepted]
PHST- 2017/01/13 06:00 [pubmed]
PHST- 2017/09/01 06:00 [medline]
PHST- 2017/01/13 06:00 [entrez]
AID - 11072 [pii]
PST - ppublish
SO  - Clin Exp Rheumatol. 2017 Jul-Aug;35(4):689-699. Epub 2017 Jan 5.