Tofacitinib or Adalimumab versus Placebo for Psoriatic Arthritis

N Engl J Med 2017; 377:1537-50. DOI: 10.1056/NEJMoa1615975

In the Phase 3 OPAL Broaden trial of patients with active psoriatic arthritis (PsA) with inadequate response to ≥1 csDMARD, superior efficacy was observed in patients treated with tofacitinib (TOF) compared with those given placebo. Patients were randomised to: 5 mg TOF BID, 10 mg TOF BID, 40 mg adalimumab administered subcutaneously q2W, or placebo with a switch to 5 mg TOF at Month 3. Adalimumab was used as an active control in the study. A variety of primary and secondary endpoints were used to test the efficacy of TOF. Primary endpoints, at Month 3, were ACR20 response rates and change from baseline HAQ-DI score. Secondary endpoints included: ACR 50/70 response rates, PASI75 and DAS-28 CRP score.Both 5 mg and 10 mg TOF doses showed significantly greater ACR20 response and HAQ-DI change from baseline score at Month 3 compared with placebo. AEs were more frequent with TOF compared with placebo. Rates of non-progression of joint damage were similar in all treatment groups over the 12-month study period. Conclusions suggest that further research is needed to assess the long-term efficacy and safety of TOF in patients with PsA.