Differences and Similarities in Clinical and Functional Responses Among Patients Receiving Tofacitinib Monotherapy, Tofacitinib Plus Methotrexate, and Adalimumab Plus Methotrexate: A Post-hoc Analysis of Data From Oral Strategy
Abstract BackgroundThis post-hoc analysis assessed clinical and functional responses to tofacitinib monotherapy, tofacitinib + methotrexate (MTX), and adalimumab + MTX, in patients with rheumatoid arthritis enrolled in the ORAL Strategy study, including evaluation of patient-level data using cumulative probability plots.MethodsIn the 12-month, phase IIIb/IV ORAL Strategy study, patients with rheumatoid arthritis and an inadequate response to MTX were randomized to receive tofacitinib 5 mg twice daily (BID), tofacitinib 5 mg BID + MTX, or adalimumab 40 mg every other week + MTX. In this post-hoc analysis, cumulative probability plots were generated for mean percent change from baseline (%∆) in Clinical Disease Activity Index (CDAI; clinical response) and mean change from baseline (∆) in Health Assessment Questionnaire-Disability Index (HAQ-DI; functional response) at month 12. Median C-reactive protein (CRP) levels by time period were summarized by CDAI remission (≤2.8) status at months 6 and 12. ResultsData for 1146 patients were analyzed. At month 12, cumulative probability plots for %∆CDAI and ∆HAQ-DI were similar across treatments in patients with greater response. At lower levels of response, patients receiving tofacitinib monotherapy did not respond as well as those receiving combination therapies. With tofacitinib + MTX, numerically higher baseline CRP levels and numerically larger post-baseline CRP reductions were seen in patients achieving CDAI remission at months 6 and 12 vs those who did not.ConclusionsThese results suggest that patients with a greater response did well, irrespective of which therapy they received. Patients with lesser response had better outcomes with combination therapies vs tofacitinib monotherapy, suggesting they benefitted from MTX. High pre‑treatment CRP levels may be associated with better response to tofacitinib + MTX. Trial registrationClinicalTrials.gov, NCT02187055. Registered 08 July 2014, https://clinicaltrials.gov/ct2/show/NCT02187055?term=NCT02187055&draw=2&rank=1