Comparing tofacitinib and baricitinib for patients with rheumatoid arthritis in a real-world setting

This study compared the effectiveness and safety of tofacitinib (Xeljanz) and baricitinib (Olumiant) in patients with rheumatoid arthritis in a real-world setting. The data showed that tofacitinib and baricitinib had similar effectiveness and safety but clinical responses may depend on previous use of anti-rheumatic drugs.

RA is a chronic inflammatory, autoimmune disease that causes joint pain, swelling, and stiffness. Biological disease-modifying anti-rheumatic drugs (bDMARDs) are important in the management of RA. bDMARDs lower disease activity and can assist patients in achieving remission. Janus kinase (JAK) inhibitors are becoming progressively important to RA management. JAK inhibitors act by blocking the JAK pathway that is involved in inflammatory processes.

Tofacitinib is a non-selective first-generation JAK inhibitor that was shown to be effective in treating patients with RA of different statuses. Another first-generation JAK inhibitor, baricitinib, has also produced favorable results based on phase III clinical studies. Tofacitinib and baricitinib target different levels of the JAK pathway so a head-to-head comparison is useful to determine real-world effectiveness.

The study included 242 patients with RA. 161 patients were treated with tofacitinib, while 81 patients received baricitinib. Patients were given 5 mg of tofacitinib, once or twice daily, or 4 mg/2 mg of baricitinib once daily with or without background methotrexate (MTX; Otrexup). Clinical disease activity and side effects were assessed for 24 weeks.

The average reductions in disease activity score (DAS28-ESR; a standardized scale to evaluate disease activity) were by 1.57 for tofacitinib and 1.46 for baricitinib.

31.7% of patients treated with tofacitinib had a DAS28-ESR score of 2.6 to less than 3.2, compared to 45.7% of patients treated with baricitinib. No significant differences in DAS28-ESR scores occurred between treatment groups without background MTX.

There were no significant differences in clinical responses between both groups.

Herpes zoster infection was the most common adverse effect observed in both treatment groups.

The study showed that tofacitinib and baricitinib produced simlar results for effectiveness and safety in patients with RA. The authors suggested that previous use of DMARDs may have influence response to the drugs.

The study included a small number of patients and the observation period was short.