Background/Purpose: Tofacitinib (TOFA) is an oral, small molecule drug used for rheumatoid arthritis (RA) treatment as an alternative option to biologic disease modifying antirheumatic drugs (bDMARDs) including tumor necrosis factor inhibitors (TNFi). We aimed to evaluate physician and patient reported effectiveness outcomes in TNFi compared to TOFA, using real-world data from the Ontario Best Practices Research Initiative (OBRI).

Methods: RA patients enrolled in the OBRI initiating their TOFA or TNFi (Adalimumab, Certolizumab, Etanercept, Golimumab, Infliximab, and Biosimilars) between 1st June 2014 (TOFA approval date in Canada) and 31st Dec 2019 were included. Patients were required to have physician and patient reported effectiveness outcomes data available at treatment initiation and 6-month (± 2 months) follow-up. These included clinical disease activity index (CDAI), rheumatoid arthritis disease activity index (RADAI), HAQ-DI, sleep problem, and anxiety/depression scores. Multiple imputation (Imputation Chained Equation, N=20) was used to deal with missing data for covariates at treatment initiation. To deal with confounding by indication, we estimated propensity scores for covariates with an absolute standard difference greater than 0.1 between the two treatment groups.

Results: A total of 419 patients were included. Of those, 226 were initiating a TNFi and 193 TOFA, and had a mean (SD) disease duration of 8.0 (8.7) and 12.6 (9.6) years, respectively. In the TNFi group, 81.9% were female and mean age (SD) at treatment initiation was 56.6 (13.4) years. In the TOFA group, 85% were female and mean (SD) age at treatment initiation was 60.3 (11.2) years. The TNFi group was less likely to have prior biologic use (21.7%) compared to the TOFA group (67.9%). At treatment initiation, physical function measured by HAQ-DI was significantly lower in TNFi compared to the TOFA group (1.2 vs.1.4).

The rate of CDAI LDA/remission at 6 months was 33.6% and 26.4% in TNFi and TOFA group, respectively. The generalized linear mixed models (GLMM) adjusting for propensity score quantile, showed that there was no significant difference in CDAI LDA/remission (ORs: 0.85, 95% CI: 0.51, 1.43), RADAI (β-coefficient: 0.48, 95% CI: -0.18, 1.14), HAQ-DI (β-coefficient: -0.01, 95% CI: -0.18, 0.16), sleep problems (β-coefficient: -0.25, 95% CI: -0.95, 0.45), and anxiety/depression scores (β-coefficient: 0.12, 95% CI: -0.35, 0.58) between the two treatment groups (TOFA used as reference).

Conclusion: In this real-world data study, we found that, physician and patient reported effectiveness outcomes are similar in the TNFi and TOFA groups 6 months after treatment initiation in patients with RA.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/physician-and-patient-reported-effectiveness-outcomes-are-similar-in-tofacitinib-and-tnf-inhibitors-in-rheumatoid-arthritis-patients-data-from-a-rheumatoid-arthritis-registry-in-canada/