Session Type: Abstract Submissions (ACR)
Background/Purpose: Tofacitinib was developed as a small molecule inhibitor of the Janus kinase (JAK) pathways that are central to the maintenance of the inflammatory state in rheumatoid arthritis.
Methods: To evaluate the efficacy and safety of tofacitinib, we conducted a comprehensive search in the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, CINAHL, EMBASE, Web of Science, International Pharmaceutical Abstracts (IPA) database and Biological abstracts from inception through February 2013. We included any randomized controlled trial comparing tofacitinib alone or in combination with any DMARD versus placebo or other traditional or biologic DMARDs for the treatment of patients with rheumatoid arthritis. Study selection, data collection and risk of bias assessment were performed by two independent reviewers. We performed a meta-analysis when there was more than one study reporting in the percent of patients achieving an ACR50 response, clinical remission (DAS <2.6), discontinuations due to adverse events and serious adverse events.
Results: Out of 310 citations, 10 RCTs met our inclusion criteria. Most studies compared more than two doses of tofacitinib, for our review we only evaluated the recommended dose of 5 mg twice daily. Greater percentage of patients in the tofacitinib group achieved an ACR 50 response and clinical remission compared to control (placebo + MTX) at 6-24 weeks (RR 3.4 95% CI 2.3, 5.0 and 3.1 95% CI 1.4, 6.7, respectively). There were no differences between groups in the rate of discontinuations. Serious adverse events were less likely to occur in the tofacitinib group 0.10 (95% CI 0.02, 0.55) at 12-24 weeks. When compared tofacitinib with adalimumab, similar rates of ACR50 response, discontinuations due to adverse events and serious adverse events were observed between groups.
Conclusion: Tofacitinib had better efficacy responses compared to placebo at 6-24 weeks and rates of serious adverse events or discontinuations were similar between groups. Tofacitinib had also similar effects compared to adalimumab. Tofacitinib can be considered an additional therapeutic option with different mechanisms of action to treat patients with moderate to severe disease.
M. A. Lopez-Olivo,
M. E. Suarez-Almazor,
« Back to 2013 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/tofacitinib-for-rheumatoid-arthritis-a-systematic-review-and-meta-analysis/