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Tofacitinib dans la polyarthrite rhumatoïde: le manque de changement précoce dans l'activité de la maladie prédit une faible probabilité d’atteindre une activité faible de la maladie au 6ème mois

Van Vollenhoven RF, Lee EB, Fallon L, Zwillich SH, Wilkinson B, Chapman D, Demasi R, Keystone E. - Arthritis Care Res (Hoboken) 2019 Jan;71(1):71-79. DOI: 10.1002/acr.23585

This post-hoc analysis of two, Phase 3 studies, ORAL Start and ORAL Standard shows that early treatment response can predict long-term disease activity outcomes.

EULAR recommendations suggest that treat-to-target strategies require regular target assessments with treatment approaches changed if targets are not reached at 6 months. To optimize this strategy, therapy outcomes should be known, and the relationship between short and long-term outcomes defined. The current analysis focused on the disease activity outcomes in patients given tofacitinib (TOF) versus methotrexate (MTX) or adalimumab (ADA).
ORAL Start¹ was a 24-month TOF study in MTX-naïve patients, and ORAL Standard² was a 12-month TOF study in MTX-IR patients. Patients achieving CDAI and DAS28-ESR low disease activity (LDA) and remission rates were recorded periodically over 1 year of each study. Probabilities for achieving LDA and remission were calculated for both studies.

At 6 months, a significantly greater proportion of patients achieved CDAI LDA when given TOF versus MTX or PBO. Over 85% of patients given TOF 5 mg BID who failed to achieve improvement thresholds at 3 months, failed to achieve LDA or remission at 6 months or 1 year. Slightly lower percentage values were observed for TOF 10 mg BID not achieving LDA at 3 months and failing to achieve them at later time points. Results suggested that achievement responses at 3 months were more predictive of long-term responses compared with 1-month achievement responses.

The authors found that early treatment response predicted long-term patient outcomes, with early response patterns proposed as a factor to be considered when assessing treatment continuation with TOF.

1. Lee EB, et al. N Engl J Med 2014;370:2377–86
2. Van Vollenhoven RF, et al. N Engl J Med 2012;367:508–19

Mots clefs: JAK, Tofacitinib, Clinical, Efficacy

Access original article via Pubmed

Upload date: May 2018

Traduit par: Helena Farese

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