PMID- 33958440
OWN - NLM
STAT- MEDLINE
DCOM- 20210831
LR  - 20210831
IS  - 2056-5933 (Electronic)
IS  - 2056-5933 (Linking)
VI  - 7
IP  - 2
DP  - 2021 May
TI  - Tofacitinib versus tocilizumab in the treatment of biological-naive or previous 
      biological-failure patients with methotrexate-refractory active rheumatoid 
      arthritis.
LID - 10.1136/rmdopen-2021-001601 [doi]
LID - e001601
AB  - OBJECTIVES: To compare effectiveness between tofacitinib and tocilizumab 
      treatments for biological disease-modifying antirheumatic drug (bDMARD)-naive 
      patients or previous bDMARD-failure patients with active rheumatoid arthritis 
      (RA) refractory to methotrexate (MTX). METHODS: We used two ongoing real-world 
      registries of patients with RA who had first started tofacitinib or tocilizumab 
      between August 2013 and February 2019 at our institutions. Clinical disease 
      activity index (CDAI)-based improvements at 12 months were used for comparisons 
      between tofacitinib and tocilizumab treatments, separately for bDMARD-naive and 
      previous bDMARD-failure patients. RESULTS: A total of 464 patients with RA with 
      high or moderate CDAI were enrolled (247 with tofacitinib and 217 with 
      tocilizumab). After adjustments for treatment-selection bias by propensity score 
      matching, we showed that tofacitinib was more likely to induce and maintain >/=85% 
      improvement in CDAI (CDAI85), CDAI70 and remission at 12 months compared with 
      tocilizumab in bDMARD-naive patients. After adjusting for concurrent use of MTX 
      and prednisolone, the ORs of tofacitinib versus tocilizumab were 3.88 (95% CI 
      1.87 to 8.03) for CDAI85, 2.89 (95% CI 1.43 to 5.84) for CDAI70 and 3.31 (95% CI 
      1.69 to 6.48) for remission. These effects were not observed in bDMARD-failure 
      patients. In tofacitinib treatment for bDMARD-failure patients, the number of 
      previously failed bDMARD classes was not associated with CDAI-based improvements. 
      The rate of overall adverse events was similar between both treatments. Similar 
      ORs were obtained from patients adjusted by inverse probability of treatment 
      weighting. CONCLUSIONS: Compared with tocilizumab, tofacitinib can induce greater 
      improvements during the first 12-month treatment in bDMARD-naive patients, but 
      this difference was not observed in previous bDMARD-failure patients.
CI  - (c) Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
      commercial re-use. See rights and permissions. Published by BMJ.
FAU - Mori, Shunsuke
AU  - Mori S
AUID- ORCID: 0000-0001-7972-4252
AD  - Rheumatology, National Hospital Organisation Kumamoto Saishun Medical Center, 
      Koshi, Japan mori.shunsuke.ra@mail.hosp.go.jp.
FAU - Urata, Yukitomo
AU  - Urata Y
AUID- ORCID: 0000-0002-5424-2203
AD  - Rheumatology, Tsugaru General Hospital United Municipalities of Tsugaru, 
      Goshogawara, Japan.
FAU - Yoshitama, Tamami
AU  - Yoshitama T
AD  - Rheumatology, Yoshitama Clinic for Rheumatic Diseases, Kirishima, Japan.
FAU - Ueki, Yukitaka
AU  - Ueki Y
AD  - Rheumatic and Collagen Disease Center, Sasebo Chuo Hospital, Sasebo, Japan.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - RMD Open
JT  - RMD open
JID - 101662038
RN  - 0 (Antibodies, Monoclonal, Humanized)
RN  - 0 (Antirheumatic Agents)
RN  - 0 (Biological Products)
RN  - 0 (Piperidines)
RN  - 0 (Pyrimidines)
RN  - 87LA6FU830 (tofacitinib)
RN  - I031V2H011 (tocilizumab)
RN  - YL5FZ2Y5U1 (Methotrexate)
SB  - IM
MH  - Antibodies, Monoclonal, Humanized
MH  - *Antirheumatic Agents/adverse effects
MH  - *Arthritis, Rheumatoid/drug therapy
MH  - *Biological Products/therapeutic use
MH  - Humans
MH  - Methotrexate/adverse effects
MH  - Piperidines
MH  - Pyrimidines
PMC - PMC8103932
OTO - NOTNLM
OT  - antirheumatic agents
OT  - arthritis
OT  - biological therapy
OT  - rheumatoid
OT  - therapeutics
COIS- Competing interests: SM has received lecture fees from Pfizer Japan, Chugai 
      Pharmaceutical Co, Astellas Pharma, Bristol-Myers Squibb K.K., Eisai Co, AbbVie 
      GK, AYUMI Pharmaceutical Co, Asahi Kasei Pharma Co, Janssen Pharmaceutical K.K. 
      and Mitsubishi Tanabe Pharma Co. YUrata has received lecture fees from Eli Lilly 
      Japan K.K., Pfizer Japan and Chugai Pharmaceutical Co. YY has received lecture 
      fees from Chugai Pharmaceutical Co, Bristol-Myers Squibb K.K., Mitsubishi Tanabe 
      Pharma Co, Pfizer Japan, Janssen Pharmaceutical K.K., Takeda Pharmaceutical Co, 
      Eli Lilly Japan K.K., AbbVie GK, AYUMI Pharmaceutical Co, Nippon Kayaku Co, Eisai 
      Co, Teijin Pharma, UCB Japan Co, Boehringer Ingelheim, Nippon Zoki Pharmaceutical 
      Co and Asahi Kasei Pharma Co. YUeki has received lecture fees from Chugai 
      Pharmaceutical Co, Bristol-Myers Squibb K.K., Mitsubishi Tanabe Pharma Co, Pfizer 
      Japan, Janssen Pharmaceutical K.K., Takeda Pharmaceutical Co, Eli Lilly Japan 
      K.K., Astellas Pharma, Ono Pharmaceutical Co and Asahi Kasei Pharma Co.
EDAT- 2021/05/08 06:00
MHDA- 2021/09/01 06:00
PMCR- 2021/05/05
CRDT- 2021/05/07 06:33
PHST- 2021/01/27 00:00 [received]
PHST- 2021/04/13 00:00 [revised]
PHST- 2021/04/22 00:00 [accepted]
PHST- 2021/05/07 06:33 [entrez]
PHST- 2021/05/08 06:00 [pubmed]
PHST- 2021/09/01 06:00 [medline]
PHST- 2021/05/05 00:00 [pmc-release]
AID - rmdopen-2021-001601 [pii]
AID - 10.1136/rmdopen-2021-001601 [doi]
PST - ppublish
SO  - RMD Open. 2021 May;7(2):e001601. doi: 10.1136/rmdopen-2021-001601.