Background/Purpose: The use of combination biologic and targeted synthetic DMARDs remains controversial due to safety concerns, yet may offer benefit in refractory inflammatory arthritis. This study examines the outcomes of patients treated with a combination of tofacitinib and TNF inhibitors.

Methods: We retrospectively analyzed patients with inflammatory arthritis treated with both tofacitinib and TNF inhibitors at our tertiary care centre. Demographic details, comorbidities, diagnosis, prior DMARD exposure, treatment duration, clinical response, adverse events, and remission status were recorded.

Results: A total of 10 patients were included: Spondyloarthritis (n=7), Rheumatoid arthritis (n=2), and Juvenile Idiopathic Arthritis (n=1). Except for one axial SpA patient, all had failed ≥2 conventional DMARDs and either tofacitinib or a TNF inhibitor previously.The total follow-up duration was 131 patient-months. At last follow-up, 9 patients were in complete remission and 1 in partial remission. No patient discontinued therapy due to adverse effects. No serious infections, tuberculosis, or hospitalizations were reported. Only limited use of additional DMARDs was required. No patient was on steroids at last follow up.

Conclusion: In this real-world Indian cohort, combination therapy with tofacitinib and TNF inhibitors was effective in selected patients with refractory inflammatory arthritis, with a favorable safety profile. Larger, prospective studies are warranted to confirm these findings and guide clinical practice.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/real-world-outcomes-of-combined-tofacitinib-and-tnf-inhibitor-therapy-in-refractory-inflammatory-arthritis-a-tertiary-care-experience-from-india/