Support for TNF inhibitor–csDMARD combination therapy in RA patients
medwireNews: Tumor necrosis factor (TNF) inhibitors, but not other biologics or tofacitinib, may need to be given in combination with conventional synthetic (cs)DMARDs for optimal benefits in patients with rheumatoid arthritis (RA), researchers suggest.
These findings are based on a real-world analysis of a Swiss RA registry including 2600 patients who started 4023 courses of treatment between 2013 and 2019, including 1862 initiations of TNF inhibitors, 1355 of other biologic DMARDs, and 806 of the Janus kinase (JAK) inhibitor tofacitinib.
Axel Finckh (University Hospitals Geneva, Switzerland) and team found “generally limited overall drug maintenance,” with 52.3% of the 4023 treatments discontinued over a median follow-up of 3 years.
Patients were a significant 29% more likely to discontinue TNF inhibitors compared with tofacitinib, with median treatment durations of 17 months and 25 months, respectively, whereas the likelihood of discontinuation was comparable for other biologics versus tofacitinib.
In a multivariable analysis, people treated with TNF inhibitor monotherapy had a significant 27% higher probability of treatment discontinuation than those taking a TNF inhibitor in combination with a csDMARD, but rates of treatment maintenance with other biologics and tofacitinib were comparable regardless of whether the agents were given as monotherapy or in combination with csDMARDs.
The team found that insufficient effectiveness was the most frequent reason for treatment discontinuation, reported in 57%, 50%, and 46% of patients taking TNF inhibitors, other biologics, and tofacitinib, respectively, followed by intolerance or adverse events, reported in a corresponding 19%, 22%, and 30%.
Together, these findings suggest that “[c]oncomitant csDMARDs appear to be required for optimal effectiveness of TNF [inhibitors], but not for [other biologics] or [tofacitinib],” write Finckh and colleagues in RMD Open.
They say that their results also “confirm that JAK [inhibitors], represented here by [tofacitinib], are a valuable alternative to available treatment options in RA, with good ‘real-world’ effectiveness outcomes.”
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