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Tofacitinib Persistence in Patients with Rheumatoid Arthritis: A Retrospective Cohort Study

Author

J Rheumatol. 2020 Oct 1;jrheum.191252. doi: 10.3899/jrheum.191252. Online ahead of print.

Anat Fisher 1, Marie Hudson 1, Robert W Platt 1, Colin R Dormuth, Canadian Network for Observational Drug Effect Studies (CNODES) Investigators

Author Information

1 CNODES, a collaborating center of the Drug Safety and Effectiveness Network (DSEN), is funded by the Canadian Institutes of Health Research (Grant Number DSE-111845 and DSE-146021). A. Fisher, Research Associate, MD, PhD, C.R. Dormuth, Associate Professor, ScD, Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia; M. Hudson, Associate Professor, MD, Division of Rheumatology, Jewish General Hospital and Lady Davis Institute, Department of Medicine, McGill University, Montreal, Québec; R.W. Platt, Professor, PhD, Departments of Pediatrics and of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada. The opinions, results, and conclusions reported in this paper are those of the authors. No endorsement by the data holder is intended, nor should it be inferred. Address correspondence to Dr. A. Fisher, University of British Columbia, Department of Anesthesiology, Pharmacology and Therapeutics, 2176 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada. Email: anat.fisher@ti.ubc.ca. Accepted for publication April 16, 2020.

Abstract

Objective: To compare medication persistence of tofacitinib with persistence of injectable biological disease-modifying antirheumatic drugs (bDMARD) in patients with rheumatoid arthritis (RA).

Methods: We performed a retrospective new-user cohort study of patients with RA in the IBM MarketScan Research Databases. New users of tofacitinib or bDMARD were identified between November 2012 and December 2016. Persistence, in number of years, was the time between treatment initiation and the earliest occurrence of discontinuation or switching from the medication prescribed at cohort entry. Persistence of tofacitinib was compared with bDMARD persistence using Cox proportional hazards regression with adjustment for high-dimensional propensity scores. Similar methods were used for an analysis of post first-line therapy in patients who switched to tofacitinib from a bDMARD.

Results: New tofacitinib users (n = 1031) were 56 years of age, on average, and 82% were women. New bDMARD users (n = 17,803) were 53 years of age, on average, and 78% were women. New tofacitinib users had shorter medication persistence (median 0.81 yrs) compared to bDMARD patients (1.02 yrs). After adjustment, the HR for discontinuation of tofacitinib compared with bDMARD was 1.14 (95% CI 1.05-1.25). Patients who switched to tofacitinib from a bDMARD had longer persistence than patients who switched to a bDMARD (adjusted HR for discontinuation 0.90, 95% CI 0.83-0.97).

Conclusion: 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.