Intern Med. 2018 Mar 1;57(5):663-670. doi: 10.2169/internalmedicine.9341-17This 6-month prospective direct comparison study analysed the effectiveness of tofacitinib (TOF) therapy on bDMARD-naïve and bDMARD-experienced patients. bDMARD-naïve patients were more responsive to TOF therapy than bDMARD-experienced patients.The study analysed the data of 113 patients diagnosed with high or moderate disease activity, defined using CDAI scores. All patients had failed to achieve CDAI low disease activity or remission with MTX therapy for ≥3 months. Patients were given 5 mg TOF BID, either as monotherapy or in combination with MTX, for 6 months. Baseline scores were taken at Month 0, 3 and 6, with a multivariate logistic regression analysis performed after the follow-up data was collected. bDMARD-naïve patients were significantly more likely to achieve CDAI50 than experienced patients, (80.6% vs 46.8%, respectively) and remission rates were also higher in these patients (41.7% vs 11.7%, respectively). Statistical analysis also revealed that previous use of bDMARDs was a strong risk factor for failing to achieve CDAI50 response in patients given TOF. The authors concluded that TOF is less effective in patients who have previously failed bDMARDs, but TOF is still considered an effective treatment option for MTX-refractory RA patients.