Estimated Medical Expenditure and Risk of Job Loss among Rheumatoid Arthritis Patients undergoing Tofacitinib Treatment: Post Hoc Analyses of Two Randomized Clinical Trials

Rheumatology doi: 10.1093/rheumatology/kex087

The results of this post hoc analysis of two Phase 3 studies of tofacitinib (TOF) show that improvements in health-related quality of life related to TOF treatment are likely to translate into significant reductions in estimated medical expenditure and likelihood of current and future job loss. Data from 399 MTX inadequate responder (IR) patients from ORAL Step, and 716 TNF inhibitor (TNFi)-IR patients from ORAL Standard were included in this analysis. Patients were receiving 5 mg or 10 mg TOF BID, adalimumab 40 mg Q2W (ORAL Standard only) or placebo. SF36 physical and mental component summary scores were used to calculate predicted monthly medical expenditure (MME) and concurrent inability to work and job loss risks at 6, 12 and 24 months. Among TNFi-IRs, statistically significant differences compared with placebo were observed for both TOF treatment groups as early as two weeks. Patients who had received placebo until Month 3 experienced a decrease in MME by Month 6 after switching to active treatment. After one month of TOF 10 mg BID, MTX-IRs had a mean MME $89 less than those treated with placebo (P<0.001); mean MME of patients receiving TOF 5 mg BID or adalimumab was $70 less than patients receiving placebo (P≤0.001 for both).In terms of job loss, for TNFi-IRs at Month 3 the odds of being unable to work decreased by 19% and 23% in the 5 mg and 10 mg groups, respectively, while it increased by 17% in the placebo-treated patients. Similar trends were again seen in the MTX-IR group.These findings show that as well as clinical efficacy, treatment with TOF may be associated with meaningful improvements in additional outcomes.