TOPLINE

Among patients with rheumatoid arthritis (RA), tofacitinib monotherapy demonstrated similar real-world treatment persistence to tofacitinib combined with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs).

METHODOLOGY

• Researchers conducted a retrospective study using routine care data from six Dutch cohorts to compare the real-world effectiveness of tofacitinib and adalimumab, used alone or in combination with csDMARDs, in patients with RA.
• A total of 2684 adults with RA were included: 408 initiated tofacitinib (56% on monotherapy and 44% on combination therapy with csDMARDs) and 2380 initiated adalimumab (43% on monotherapy and 57% on combination therapy) between 2001 and 2022; all had at least one follow-up visit.
• The primary outcome was drug survival, on the basis of the time from treatment initiation to discontinuation of tofacitinib or adalimumab, with a Disease Activity Score in 28 joints of 2.6 or above at discontinuation; drug survival was used as an indirect measure of treatment persistence.
• The analysis also assessed whether treatment persistence was modified by anti-citrullinated protein antibody (ACPA) status and age.

TAKEAWAY

• Compared with tofacitinib monotherapy, the overall risk for drug discontinuation did not differ significantly for tofacitinib combination therapy and adalimumab monotherapy but was lower for adalimumab combination therapy (adjusted hazard ratio, 0.78; P = .02).
• ACPA status did not appear to modify drug survival, whereas age modified the effect of treatment on drug survival.

IN PRACTICE

"The results of this study suggest that real-world drug survival, evaluated as an indirect measure of treatment persistence, did not differ significantly between tofacitinib monotherapy and combination therapy across ACPA subgroups," the authors wrote.

SOURCE

The study was led by Isabell S. Nevins, Leiden University Medical Center, Leiden, Netherlands. It was published online on August 19, 2026, in Clinical Rheumatology.

LIMITATIONS

The retrospective design of the study may have resulted in missing data, non-standardised data collection, uncertain treatment adherence, and non-randomised treatment assignment. Residual channelling bias may have affected the results. Information on prior treatment was incomplete for many tofacitinib-treated patients.

DISCLOSURES

The study was funded by an ASPIRE grant from Pfizer. Two authors reported receiving grants, consulting fees, or speaker fees from multiple pharmaceutical companies including Pfizer.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.