Cytokine Signalling Forum

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Comparative effectiveness of antitumour necrosis factor agents, biologics with an alternative mode of action and tofacitinib in an observational cohort of patients with rheumatoid arthritis in Switzerland

Finckh A, Tellenbach C, Herzog L, Scherer A, Moeller B, Ciurea A, von Muehlenen I, Gabay C, Kyburz D, Brulhart L, Müller R, Hasler P, Zufferey P. - RMD Open 2020;6:e001174 doi:10.1136/rmdopen-2020-001174

This nested cohort study found that, in Switzerland, there was a generally limited overall drug maintenance for b/tsDMARD options in RA. Using data from SCQM-RA – a prospective longitudinal registry, overall maintenance (drug survival) was calculated for TNFi, bDMARD-OMA or JAKi in patients with RA.
After adjusting for potential confounding factors, there was a higher hazard of drug discontinuation with TNFi compared with tofacitinib; no significant difference was observed between non-TNF bDMARDs and tofacitinib. Furthermore, TNFi maintenance was significantly decreased in monotherapy, but for non-TNF bDMARDs and tofacitinib there was no significant difference in survival for mono- compared with combination therapy. In this real-life registry data, the authors also found no evidence for effect modification by concomitant csDMARD use.
The generally limited overall drug maintenance for all b/tsDMARD options in RA could potentially be explained by the patient mix and liberal access to advanced agents in Switzerland favouring rapid treatment switching. Tofacitinib drug maintenance was comparable with non-TNFi bDMARDs, and somewhat higher than TNFi. Concomitant csDMARDs appear to be required for optimal effectiveness of TNFi, but not for tofacitinib or bDMARDs with other modes of action.