Relative Efficacy and Safety of Tofacitinib, Baricitinib, Upadacitinib, and Filgotinib in Comparison to Adalimumab in Patients with Active Rheumatoid Arthritis
This Bayesian network meta-analysis, comparing the relative efficacy and safety of JAK inhibitors, determined BARI 4mg + MTX and UPA 15mg + MTX were the most effective. The analysis included 5451 patients with an inadequate response to MTX and active RA, from four RCTs. Relative effects were converted into a probability allowing each treatment to be ranked.
BARI and UPA had significantly higher ACR20 response rates than ADA 40mg + MTX whilst TOF 5mg and FIL 200mg had comparable ACR20 response rates to ADA 40mg + MTX. In terms of SAEs, ADA 40mg + MTX was determined as the safest treatment whilst BARI 4mg + MTX was least safe. In terms of HZ infection, PBO + MTX was determined as the safest treatment whilst BARI 4mg + MTX was least safe. There were no statistically significant differences between JAK inhibitors and PBO in terms of safety.
The study suggests there is a difference in efficacy among the different JAK inhibitors. The study was limited by its short duration and the indirect comparison calibration relying on comparisons to both PBO + MTX and ADA + MTX.