Background/Purpose: Tofacitinib (Xeljanz) is an approved treatment for Rheumatoid Arthritis (RA) but data on its use in “real life” are limited.  We sought to analyze Tofacitinib drug retention in the Israeli registry and compare it to other mechanism of action agents (Etanercept, Golimumab, Tocilizumab, and Abatacept). Our hypothesis is that Tofacitinib drug retention is mainly influenced by the number of prior therapeutic lines and is similar to other biologic agents.

Methods: This prospective cohort study was based on data from the Israeli registry of RA, status February 2019.  We included patients with RA according to the EULAR/ACR criteria. The primary end point was “drug retention”. Episode was defined ‘time on drug’ as the period between treatment initiation and treatment discontinuation. We compared drug retention using Kaplan-Meier and Cox models over time with mixed-effects models for longitudinal data.

Results: A total of 864 eligible treatment courses (episodes) were retrieved from January 2010 until February 2019, including 111 Tofacitinib, 242 Etanercept , 99 Golimumab, 297 tocilizumab and 115 Abatacept. In the complete cohort, the median age at diagnosis and at the time of episode was 47 (range: 0.5-87) and 59 (17-88) years, respectively; median disease duration was 10 (0.5-40) years. [for Tofacitinib only: the median age at the time of episode was 66 (21-88) years; median disease duration was 14 (0.5-50) years.] Tofacitinib was mostly prescribed as third or late line of therapy (64%), similar to Abatacept (63%), (p=0.892). Tofacitinib [HR 1.92, 95% CI:1.33-2.76] as well as all drugs considered had reduced drug survival (Etanercept [HR 1.65, 95% CI:1.26-2.18], Abatacept [HR 1.89, 95% CI:1.35-2.64], Golimumab [HR 1.56, 95% CI:1.08-2.24], Tofacitinib [HR 1.92, 95% CI:1.33-2.76]), in comparison with Tocilizumab which significantly had the best retention rate, at all lines of treatment. Interestingly, Tofacitinib median drug survival (15.8 [95% CI: 8.6-23.1] months) was non-inferior to Etanercept (26.4 [95%CI: 5.9-46.9]; p=0.426), Abatacept (20.3 [95%CI: 9.8-30.9; p=0.157), and Golimumab (15.1 [95%CI: 5.9-24.3]; p=0.698) at first and second line of biologics treatment. In a multivariate analysis, an advanced treatment line was associated with reduced Tofacitinib drug survival (p< 0.05). Age at episode, the duration of disease, body mass index, concomitant use of Methotrexate with Tofacitinib (HR 1.34, 95% CI [0.62-2.90]) and smoking were not found as parameters that influence drug survival.

Conclusion: The line of treatment with Tofacitinib may have influence on its survival. Moreover, there is no statistical difference in drug retention between Tofacitinib and the other compared bDMARDs except for Tocilizumab with demonstrated a longer survival.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/real-life-retention-of-tofacitinib-in-patients-with-rheumatoid-arthritis/