Cytokine Signalling Forum

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A Comparison of Discontinuation Rates of Tofacitinib and Biologic Disease-modifying Anti-rheumatic Drugs in Rheumatoid Arthritis: a Systematic Review and Bayseian Network Meta-analysis Regression

Park JS-K, Lee MY, Jang E-J, Kim H-L, Ha D-M, Lee E-K. - Clin Exp Rheumatol 2017;35:689–99

Based on a Bayesian network meta-analysis (NMA) in patients with RA who previously showed failure with csDMARDs or biologics, discontinuation rates between tofacitinib (TOF) and biologics (TNFis, abatacept [ABT], rituximab [RTX] and tocilizumab [TCZ]) differed based on previous treatments and reasons for discontinuation.

Data were collected from randomised controlled trials (RCT) found from literature searches from the Cochrane Central Register of Controlled Trials (CENTRAL) and MEDLINE. Discontinuation rates and rate ratios (RR) of biologics relative to TOF were measured per 100 patient-months.

In csDMARD-inadequate responder (IR) patients, ABT had the lowest total and discontinuation due to AEs rates; RTX showed the lowest discontinuation rate due to lack of efficacy (LOE). The findings showed no significant differences in discontinuation rates between TOF and biologics, but suggested TCZ may have a higher rate of discontinuation due to AEs. In bDMARD-IR patients, the total discontinuation rate was lowest for TNFi biologics; TCZ had the lowest discontinuation due to LOE and AEs. Relative to TOF, TNFi and rituximab showed significantly lower total discontinuation rates but comparable discontinuation rates due to LOE and AEs.

Comparability of discontinuation rates between TOF and biologics differed based on previous treatments and reasons for discontinuation. This suggests that these factors must be considered when deciding an optimal treatment strategy.