• About
  • Masthead
  • License Content
  • Advertise
  • Submit Press Release
  • RSS/Email List
  • Write for us
  • Contact us
2 Minute Medicine
No Result
View All Result

No products in the cart.

SUBSCRIBE
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
2 Minute Medicine
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
SUBSCRIBE
2 Minute Medicine
Subscribe
Home All Specialties Chronic Disease

Tofacitinib superior to methotrexate monotherapy for rheumatoid arthritis

byMatthew Growdon,Andrew Cheung, MD MBAand1 others
June 19, 2014
in Chronic Disease
Reading Time: 3 mins read
0
Share on FacebookShare on Twitter

1. At 6 months, patients receiving tofacitinib monotherapy had reduced structural joint damage compared to methotrexate monotherapy. 

2. Patients treated with tofacitinib had increased numbers of adverse events, including herpes zoster infections and creatinine and lipid elevations.

Evidence Rating Level: 1 (Excellent)

Study Rundown: This randomized, controlled study was designed to compare the efficacy and safety profile of tofacitinib, an oral Janus kinase inhibitor, to first-line methotrexate monotherapy in the treatment of rheumatoid arthritis. The study involved three arms (tofacitinib at 5 and 10 mg daily versus methotrexate at 10 mg per week, with ability to increase to max of 20 mg per week) and continued for 2 years, though primary endpoints were powered for measurements at the 6 month time point. At 6 months, there was a significant improvement in the primary outcome measures for the tofacitinib groups versus methotrexate monotherapy. The mean change from baseline in a summary measure of radiographic evidence of joint destruction (van der Heijde modification of the total Sharp score) was smaller in the tofacitinib groups, and there was significant clinical improvement in arthritis symptoms. Importantly, however, while the difference in the Sharp score was statistically significant, the absolute changes were less than the minimal clinically important difference.

Strengths of the study include the randomized design, as well as the ability to see significant differences across a follow-up time of 2 years. Drawbacks include the inability to adjust medication dosages more frequently than every 3 months (which has been recommended) and the fact that the population was somewhat heterogeneous in terms of interval between diagnosis of rheumatoid arthritis and enrollment in the trial (less than 2 years for 65.5% of patients). The study was funded by Pfizer, the maker of tofacitinib.

Click to read the study, published today in NEJM

Relevant Reading: Therapeutic strategies for rheumatoid arthritis

RELATED REPORTS

Tofacitinib increases cardiovascular and cancer risk in rheumatoid arthritis

#VisualAbstract: Immune dysfunction is associated with a higher risk of breakthrough COVID-19 infection

#VisualAbstract: Tofacitinib reduces the rate of flare-ups in patients with polyarticular juvenile idiopathic arthritis

In-Depth [randomized controlled study]: This randomized controlled study involved 958 patients randomized to three arms: 1) tofacitinib 5 mg twice daily, tofacitinib 10 mg twice daily, or methotrexate at a starting dose of 10 mg per week (with maximum achievable dose 20 mg per week). Eligible patients were at least 18 years old, with a diagnosis of active rheumatoid arthritis (RA), elevated inflammatory markers (ESR>28 mm/hour or CRP>7 mg/L), and either radiographic evidence of joint erosions or positive rheumatoid arhtiritis antibody titers. They had not received methotrexate before.

The primary endpoints at month 6 were mean change from baseline on a standardized scoring system for radiographic joint damage (van der Heijde modification of the total Sharp score, scale from 0 to 448 with higher scores indicating greater joint damage) and the proportion of patients with at least a 70% reduction from baseline in the number of both tender and swollen joints and equivalent improvement in American College of Rheumatology (ACR)-defined clinical measures of disease severity (ACR 70 response). At 6 months, the least-squares mean changes (±SE) in the Sharp score were 0.2±0.1 points in the 5 mg tofacitinib group, <0.1±0.2 points in the 10 mg tofacitinib group, and 0.8±0.2 points in the methotrexate group (P<0.001 for both comparisons to methotrexate). These significant differences persisted at 12 and 24 months. At 6 months, the mean proportions of patients who had an ACR 70 response were 25.5%, 37.7%, and 12% in the 5 mg tofacitinib, 10 mg tofacitinib, and methotrexate  groups respectively (P<0.001 for both comparisons to methotrexate).

The most common adverse events were infections and gastrointestinal disorders. Herpes zoster infections occurred in 3.5% of the 5 mg tofacitinib group, 4.5% of the 10 mg tofacitinib group, and 1.1% of the methotrexate group. There were 6 confirmed cases of cancer (5 between the 2 tofacitinib groups vs. 1 in the methotrexate group). There were also greater increases in serum creatinine levels, LDL and HDL lipoprotein cholesterol levels, and aminotransferase levels in the tofacitinib groups compared to the methotrexate group.

More from this author: Hemicraniectomy improved survival but not functional status in MCA strokes, Broad decline in incidence rate of diabetes-related complications in US, Darapladib not effective in optimized, stable coronary heart disease patients, Letermovir safe, effective in CMV prophylaxis following stem-cell transplantation, Combination CPAP, weight loss for obstructive sleep apnea offer no added benefit

Image: PD

©2012-2014 2minutemedicine.com. All rights reserved. No works may be reproduced without expressed written consent from 2minutemedicine.com. Disclaimer: We present factual information directly from peer reviewed medical journals. No post should be construed as medical advice and is not intended as such by the authors, editors, staff or by 2minutemedicine.com. PLEASE SEE A HEALTHCARE PROVIDER IN YOUR AREA IF YOU SEEK MEDICAL ADVICE OF ANY SORT. 

Tags: methotrexaterheumatoid arthritistofacitinib
Previous Post

No link between antidepressant use in pregnancy and fetal cardiac abnormalities

Next Post

Mental health patients at greater risk of becoming victims of homicide

RelatedReports

2 Minute Medicine Rewind January 28, 2019
Cardiology

Tofacitinib increases cardiovascular and cancer risk in rheumatoid arthritis

February 2, 2022
#VisualAbstract: Immune dysfunction is associated with a higher risk of breakthrough COVID-19 infection
StudyGraphics

#VisualAbstract: Immune dysfunction is associated with a higher risk of breakthrough COVID-19 infection

January 5, 2022
#VisualAbstract: Tofacitinib reduces the rate of flare-ups in patients with polyarticular juvenile idiopathic arthritis
StudyGraphics

#VisualAbstract: Tofacitinib reduces the rate of flare-ups in patients with polyarticular juvenile idiopathic arthritis

December 16, 2021
Pediatric palliative care outcome measures often miss quality of life
Chronic Disease

Tofacitinib reduces the rate of flare-ups in patients with polyarticular juvenile idiopathic arthritis

December 7, 2021
Next Post
Patient transfers to trauma centers often unnecessary

Mental health patients at greater risk of becoming victims of homicide

Antibodies against apoptotic cells may predict kidney transplant rejection

Antibodies against apoptotic cells may predict kidney transplant rejection

Meniscal allograft transplantation may improve knee function

Meniscal allograft transplantation may improve knee function

License Our Award-Winning Physician-Written Medical News and Visual Abstracts

2 Minute Medicine is the leading authoritative medical news licensing service, and the only with reports written by practicing doctors.

LICENSE CONTENT

Get 2MM+ Premium Access

No ads & unlimited access to all current reports, over 9000 searchable archived reports, visual abstracts, Weekly Rewinds, and the online edition of The Classics Series™ textbook.

Subscription Options
2 Minute Medicine

2 Minute Medicine® is an award winning, physician-run, expert medical media company. Our content is curated, written and edited by practicing health professionals who have clinical and scientific expertise in their field of reporting. Our editorial management team is comprised of highly-trained MD physicians. Join numerous brands, companies, and hospitals who trust our licensed content.

Recent Reports

  • #VisualAbstract: Severe actinic keratosis and need for additional treatment are markers for an increased risk of cutaneous squamous cell carcinoma
  • Virtual yoga and meditation intervention may be associated with increased health-related quality of life
  • Wellness Check: Mental Health
License Content
Terms of Use | Disclaimer
Cookie Policy
Privacy Statement (EU)
Disclaimer

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.