PMID- 36878650 OWN - NLM STAT- MEDLINE DCOM- 20230308 LR - 20230309 IS - 2044-6055 (Electronic) IS - 2044-6055 (Linking) VI - 13 IP - 3 DP - 2023 Mar 6 TI - Discontinuation of tofacitinib and TNF inhibitors in patients with rheumatoid arthritis: analysis of pooled data from two registries in Canada. PG - e063198 LID - 10.1136/bmjopen-2022-063198 [doi] LID - e063198 AB - OBJECTIVES: The similarity in retention of tumour necrosis factor inhibitors (TNFi) and tofacitinib (TOFA) was previously reported separately by the Ontario Best Practices Research Initiative and the Quebec cohort Rhumadata. However, because of small sample sizes in each registry, we aimed to confirm the findings by repeating the analysis of discontinuation of TNFi compared with TOFA, using pooled data from both these registries. DESIGN: Retrospective cohort study. SETTING: Pooled data from two rheumatoid arthritis (RA) registries in Canada. PARTICIPANTS: Patients with RA starting TOFA or TNFi between June 2014 and December 2019 were included. A total of 1318 patients were included TNFi (n=825) or TOFA (n=493). OUTCOME MEASURES: Time to discontinuation was assessed using Kaplan-Meier survival and Cox proportional hazards regression analysis. Propensity score (PS) stratification (deciles) and PS weighting were used to estimate treatment effects. RESULTS: The mean disease duration in the TNFi group was shorter (8.9 years vs 13 years, p<0.001). Prior biological use (33.9% vs 66.9%, p<0.001) and clinical disease activity index (20.0 vs 22.1, p=0.02) were lower in the TNFi group.Discontinuation was reported in 309 (37.5%) and 181 (36.7%) TNFi and TOFA patients, respectively. After covariate adjustment using PS, there was no statistically significant difference between the two groups in discontinuation due to any reason HR=0.96 (95% CI 0.78 to 1.19, p=0.74)) as well as discontinuation due to ineffectiveness only HR=1.08 (95% CI 0.81 to 1.43, p=0.61)).TNFi users were less likely to discontinue due to adverse events (AEs) (adjusted HRs: 0.46, 95% CI 0.29 to 0.74; p=0.001). Results remained consistent for firstline users. CONCLUSIONS: In this pooled real-world data study, the discontinuation rates overall were similar. However, discontinuation due to AEs was higher in TOFA compared with TNFi users. CI - (c) Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Movahedi, Mohammad AU - Movahedi M AUID- ORCID: 0000-0001-6154-0121 AD - Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada mmovahed@uhnresearch.ca. AD - IHMPE, Univeristy of Toronto, Toronto, Ontario, Canada. FAU - Choquette, Denis AU - Choquette D AD - Department of Rheumatology, Institut de Rhumatologie de Montreal, Montreal, Quebec, Canada. FAU - Coupal, Louis AU - Coupal L AD - Department of Rheumatology, Institut de Rhumatologie de Montreal, Montreal, Quebec, Canada. FAU - Cesta, Angela AU - Cesta A AD - Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada. FAU - Li, Xiuying AU - Li X AD - Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada. FAU - Keystone, Edward C AU - Keystone EC AD - Department of Medicine, University of Toronto, Toronto, Ontario, Canada. FAU - Bombardier, Claire AU - Bombardier C AD - Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada. AD - IHMPE, Univeristy of Toronto, Toronto, Ontario, Canada. AD - Department of Medicine, University of Toronto, Toronto, Ontario, Canada. FAU - Investigators, Obri AU - Investigators O AD - Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada. LA - eng PT - Journal Article DEP - 20230306 PL - England TA - BMJ Open JT - BMJ open JID - 101552874 RN - 0 (Tumor Necrosis Factor Inhibitors) RN - 87LA6FU830 (tofacitinib) SB - IM MH - Humans MH - *Tumor Necrosis Factor Inhibitors/therapeutic use MH - Retrospective Studies MH - Registries MH - Ontario MH - *Arthritis, Rheumatoid/drug therapy PMC - PMC9990670 OTO - NOTNLM OT - RHEUMATOLOGY OT - Rheumatology OT - THERAPEUTICS COIS- Competing interests: MM is employee at OBRI and has a faculty position (status) at University of Toronto with no conflict of interest; AC and XL are employees at OBRI with no conflict of interest. DC is the owner of the Rhumadata software and is the scientific director of Conceptmed-Rhumadata; LC, biostatistician at the Institut de Rhumatologie de Montreal, declares no conflict of interest; ECK has received sources of funding for research from Amgen, Merck and Pfizer; has a consulting agreement/is a member of an advisory board for AbbVie, Amgen, Celltrion, Myriad Autoimmune, F. Hoffmann-La Roche Inc, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, Sanofi-Genzyme, Samsung Bioepsis; and received speaker honoraria agreements for Amgen, AbbVie, Celltrion, F. Hoffmann-La Roche Inc, Janssen Inc., Merck, Pfizer Pharmaceuticals, Sandoz and Sanofi Genzyme. CB held a Canada Research Chair in Knowledge Transfer for Musculoskeletal Care and has received sources of funding for research for a longitudinal cohort study (Ontario Best Practices Research Initiative) including Psoriatic Arthritis cohort (PsA) from Abbvie, Amgen, Celgene, Gilead, GSK, Janssen, Lilly, Merck, Medexus, Medreleaf/Aurora, Novartis, Pfizer (Hospira), Roche, Sandoz, Sanofi/ Genzyme and UCB Canada Inc. EDAT- 2023/03/07 06:00 MHDA- 2023/03/09 06:00 PMCR- 2023/03/06 CRDT- 2023/03/06 21:03 PHST- 2023/03/06 21:03 [entrez] PHST- 2023/03/07 06:00 [pubmed] PHST- 2023/03/09 06:00 [medline] PHST- 2023/03/06 00:00 [pmc-release] AID - bmjopen-2022-063198 [pii] AID - 10.1136/bmjopen-2022-063198 [doi] PST - epublish SO - BMJ Open. 2023 Mar 6;13(3):e063198. doi: 10.1136/bmjopen-2022-063198.