Medication persistence shorter in new users of tofacitinib for rheumatoid arthritis

Treatment discontinuation with tofacitinib is common in patients with rheumatoid arthritis (RA) despite its ease of administration, reports a new study.

Medication persistence of tofacitinib was compared with that of injectable biological disease-modifying antirheumatic drug (bDMARD) in this retrospective new-user cohort study of RA patients in the IBM MarketScan Research Databases. The authors identified new users of tofacitinib or bDMARD between November 2012 and December 2016.

Persistence, in number of years, was defined as the time between treatment initiation and the earliest occurrence of discontinuation or switching from the medication prescribed at cohort entry. Cox proportional hazards regression was used to compare persistence of tofacitinib with that of bDMARD, with adjustment for high-dimensional propensity scores.

The authors used similar methods to analyse post first-line therapy in patients who switched to tofacitinib from a bDMARD.

A total of 1,031 tofacitinib users (mean age, 56 years; 82 percent women) and 17,803 new bDMARD users (mean age, 53 years; 78 percent women) were included in the analysis. Medication persistence was shorter among new tofacitinib users compared to bDMARD patients (median, 0.81 vs 1.02 years). After adjustment, the hazard ratio (HR) for discontinuation of tofacitinib vs bDMARD was 1.14 (95 percent confidence interval [CI], 1.05–1.25).

Furthermore, patients who switched to tofacitinib from a bDMARD had longer medication persistence than those who switched to a bDMARD (adjusted HR for discontinuation, 0.90, 95 percent CI, 0.83–0.97).

“Further research is warranted to understand the reasons for discontinuation of tofacitinib despite its ease of administration and to understand the observed differences between switchers and new users,” the authors said.