Tofacitinib in Rheumatoid Arthritis: Lack of Early Change in Disease Activity and the Probability of Achieving Low Disease Activity at Month 6

Vollenhoven, Ronald F. van; Lee, Eun Bong; Fallon, Lara; Zwillich, Samuel H.; Wilkinson, Bethanie; Chapman, Douglass; DeMasi, Ryan; Keystone, Edward

doi:10.1002/acr.23585

Cited by 6 publications

(4 citation statements)

References 30 publications

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“…Nine 2-year-cycle data from the continuous NHANES (1999-2016) were combined for analysis with greater statistical reliability (n=92 062). We excluded men (n=45 336), participants younger than 18 years (n=19 087) or older than 80 years of age (n=919), [22][23][24][25] participants who had been diagnosed with other forms of arthritis, participants with missing RA data (n=3438) or dietary magnesium information (n=9958), and 13 324 participants were eventually included in the analysis (figure 1).…”

Section: Study Populationmentioning

confidence: 99%

Relationship between dietary magnesium intake and rheumatoid arthritis in US women: a cross-sectional study

Zhu

Liu

et al. 2020

BMJ Open

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ObjectivesDiet has been shown to be associated with rheumatoid arthritis (RA), and magnesium has been shown to inhibit inflammatory responses, but research on the relationship between dietary magnesium and RA is limited and controversial. In this study, we aimed to explore the non-linear relationship between dietary magnesium intake and RA in US women.DesignCross-sectional survey.SettingNational Health and Nutrition Examination Survey (NHANES).Primary and secondary outcome measuresNon-linear relationship between dietary magnesium intake and prevalence of RA.ParticipantsA total of 13 324 women aged 18–80 years (RA n=12 306, non-RA n=1018) were included in this study.ResultsOverall, the absolute risk (AR) of RA was 7.24% in all participants. In the multivariable logistic regression analysis, we found a negative correlation between dietary magnesium intake and RA (OR=0.84, 95% CI 0.75 to 0.95, p=0.006). When we converted dietary magnesium intake into a categorical variable (tertiles), the ARs of the low group, the middle group and the high group were 9%, 7.1% and 4.9%, respectively. We noticed that the ORs between the three groups were not equidistant; then, we detected a U-shaped linking by smooth curve fitting and obtained inflection points at 181 and 446 mg/day. The prevalence of RA decreased when dietary magnesium intake was <181 mg/day (OR=0.7, 95% CI 0.5 to 0.8, p<0.001) and increased when it was >446 mg/day (OR=2.8, 95% CI 1.2 to 6.6, p=0.020), remaining at a minimum when it was between 181 and 446 mg/day (OR=1.0, 95% CI 0.7 to 1.2, p=0.700).ConclusionThere was a U-shaped relationship between dietary magnesium and RA in women, and our study highlights the importance of moderate dietary magnesium intake in possibly exerting a protective role in women with RA.

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Section: Study Populationmentioning

confidence: 99%

Relationship between dietary magnesium intake and rheumatoid arthritis in US women: a cross-sectional study

Zhu

Liu

et al. 2020

BMJ Open

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“…A post hoc analysis of two randomized, double-blind, Phase III studies explored early changes in disease activity and achievement of low activity and remission goals with tofacitinib. 21 In patients with an inadequate response to methotrexate, the lack of response to tofacitinib after one or three months predicted a low probability of achieving low disease activity by month six. 21 These results are important in guiding decision-making for continued treatment with tofacitinib in the face of a lack of early response, and stress the need to include this measurement early in the therapeutic evaluation of patients with RA.…”

Section: Discussionmentioning

confidence: 99%

“… 21 In patients with an inadequate response to methotrexate, the lack of response to tofacitinib after one or three months predicted a low probability of achieving low disease activity by month six. 21 These results are important in guiding decision-making for continued treatment with tofacitinib in the face of a lack of early response, and stress the need to include this measurement early in the therapeutic evaluation of patients with RA. Also, the multivariate analysis showed that the use of tofacitinib as first-line of treatment had a tendency toward significancy a lower response at six months but not at 12 months, showing that the use of tofacitinib achieves responses per year of treatment regardless of its use after conventional or biological therapy, as shown in other studies.…”

Section: Discussionmentioning

confidence: 99%

Is Tofacitinib Effectiveness in Patients with Rheumatoid Arthritis Better After Conventional Than After Biological Therapy? – A Cohort Study in a Colombian Population

Santos-Moreno¹,

Martínez²,

Ibatá³

et al. 2022

BTT

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Purpose Tofacitinib is recommended for treatment of rheumatoid arthritis (RA) in patients with moderate to severe disease activity, but there is not enough evidence on its effectiveness after conventional DMARDs vs its use after biologics. The aim was evaluating the effectiveness of tofacitinib in RA as first-line treatment (after conventional DMARDs) in a real-life setting in Colombian (Latin-American) patients. Patients and Methods Retrospective cohort study conducted at a specialized center for RA management. A complete statistical analysis was performed to compare the values of the change in the DAS28 at months 3, 6, and 12 in both treatment groups. Results A total of 152 RA patients who received tofacitinib: first-line 85 patients (55.9%) after failure on conventional DMARDs or second-line 67 patients (44.1%) after failure on biologic DMARDs. Comparative analysis of response to treatment showed a reduction in DAS28 at 3, 6, and 12 months in both study groups without statistical differences, but a higher proportion of first-line patients achieved remission (45% vs 23%). Nonresponse at three months were associated with no response at six months of follow-up. Baseline DAS28 was significantly associated with response at 12 months (OR: 1.87, 95%CI: 1.06–3.30, p -value 0.028). In second-line patients, response to tofacitinib was not related to number of biologic DMARDs previously used. Conclusion Tofacitinib is an effective treatment option for patients with RA, maybe better after conventional DMARDs than after biologic therapy failure. Further studies are required to determine the role of tofacitinib in different lines of RA treatment and in other groups of patients.

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“… Effects of tofacitinib as monotherapy or in combination with csDMARD on (a) disease activity at Month 6, (b) patient-reported outcomes at Month 3, and (c) radiographic progression at Month 6 in phase III and IIIb/IV studies of patients with DMARD-IR. 6 – 8 , 14 , 47 – 50 , 82 , 85 …”

Section: Appropriate Use Of Tofacitinib At Different Stages In a Pati...mentioning

confidence: 99%

Clinical scenarios-based guide for tofacitinib in rheumatoid arthritis

Mortezavi

Mysler²

2023

Therapeutic Advances in Chronic Disease

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Tofacitinib was the first Janus kinase inhibitor to be approved for the treatment of rheumatoid arthritis (RA), and there is a large body of data to inform the efficacy and safety of this drug for patients at different places in their treatment journeys and with diverse demographics and characteristics. Here, we summarize tofacitinib clinical efficacy and safety data from some clinical trials, post hoc analyses, and real-world studies, which provide evidence of the efficacy of tofacitinib in treating patients with RA at various stages of their treatment journeys, and with differentiating baseline characteristics, such as age, gender, race, and body mass index. In addition, we review the safety data available from different patient subpopulations in the tofacitinib clinical development program, real-world data, and findings from the ORAL Surveillance post-marketing safety study that included patients aged ⩾50 years with pre-existing cardiovascular risk factors. The available efficacy and safety data in these subpopulations can enable better discussions between clinicians and patients to guide informed decision-making and individualized patient care.

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Tofacitinib in Rheumatoid Arthritis: Lack of Early Change in Disease Activity and the Probability of Achieving Low Disease Activity at Month 6

Abstract: In MTX-IR patients, lack of response to tofacitinib after 1 or 3 months predicted low probability of achieving LDA at month 6. Lack of early response may be considered when deciding whether to continue treatment with tofacitinib. This article is protected by copyright. All rights reserved.

Cited by 6 publications

References 30 publications

Relationship between dietary magnesium intake and rheumatoid arthritis in US women: a cross-sectional study

Relationship between dietary magnesium intake and rheumatoid arthritis in US women: a cross-sectional study

Is Tofacitinib Effectiveness in Patients with Rheumatoid Arthritis Better After Conventional Than After Biological Therapy? – A Cohort Study in a Colombian Population

Clinical scenarios-based guide for tofacitinib in rheumatoid arthritis

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