Real-world effectiveness and safety of tofacitinib and abatacept in patients with rheumatoid arthritis

摘要

Objective We compared the 52-week effectiveness and safety of tofacitinib (TOF) and abatacept (ABT) in patients with RA in a real-world setting and investigated a role of human leucocyte antigens (HLA)-DRB1 shared epitope (SE) in the effectiveness. Methods RA patients starting TOF (n = 187) and ABT (n = 183) were enrolled. Effectiveness was compared after reducing the selection bias to a minimum using the inverse probability of treatment weighting (IPTW) based on propensity scores. The influence of SE alleles on effectiveness was compared within each treatment group. A treatment group comparison was also performed within SE-positive and SE-negative groups. Results Herpes zoster and some laboratory abnormalities were more frequent in the TOF group than in the ABT group. Patient characteristics did not differ significantly between treatment groups after adjustments with IPTW. The TOF group had a significantly higher proportion of DAS in 28 joints using ESR (DAS28-ESR) remission at week 52 than the ABT group. The DAS28-ESR at week 12 and thereafter was not affected by the copy number of SE alleles in the TOF group, but decreased significantly as the copy number increased in the ABT group. In SE-positive patients, remission and drug retention rates did not differ significantly between the two treatment groups. In SE-negative patients, the TOF group showed significantly higher remission and drug retention rates than the ABT group. Conclusion The present results suggest that TOF is more effective with regard to remission at week 52 based on treatment responses in SE-negative RA patients. Lay Summary What does this mean for patients? The introduction of biologic disease modifying anti-rheumatic drugs (bDAMRDs) and Janus kinase (JAK) inhibitors has significantly improved the prognosis of people with rheumatoid arthritis (RA). However, the efficacies of these drugs have not yet been compared sufficiently. In the present study, we observed 187 people with RA receiving tofacitinib (TOF), a JAK inhibitor, and 183 people with RA receiving abatacept (ABT), a bDMARD, for 52 weeks. We compared the effectiveness and safety of each drug. We also compared drug effectiveness in people with and without the HLA-DRB1 shared epitope (SE), which is a genetic variation associated with more severe RA. Overall, TOF was superior to ABT, with more people reaching remission at week 52. ABT was as effective as TOF in SE-positive people, whereas TOF was more effective than ABT in SE-negative people. The higher proportion of remission in the TOF group was presumably attributable to differences in treatment response in SE-negative people. Testing for the HLA-DRB1 allele might allow us to predict efficacy of ABT in people with RA.