Tofacitinib versus Methotrexate in Rheumatoid Arthritis

• Published in: The New England journal of medicine Vol. 370; no. 25; pp. 2377 - 2386
• Main Authors: Lee, Eun Bong, Fleischmann, Roy, Hall, Stephen, Wilkinson, Bethanie, Bradley, John D, Gruben, David, Koncz, Tamas, Krishnaswami, Sriram, Wallenstein, Gene V, Zang, Chuanbo, Zwillich, Samuel H, van Vollenhoven, Ronald F
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 19-06-2014
• Subjects: Administration, Oral; Adult; Antirheumatic Agents - administration & dosage; Antirheumatic Agents - adverse effects; Arthritis, Rheumatoid - blood; Arthritis, Rheumatoid - complications; Arthritis, Rheumatoid - drug therapy; Biological and medical sciences; Bones, joints and connective tissue. Antiinflammatory agents; C-reactive protein; Cancer; Cholesterol; Cholesterol - blood; Creatinine; Creatinine - blood; Diseases of the osteoarticular system; Dose-Response Relationship, Drug; Double-Blind Method; Drug therapy; Enzyme inhibitors; Erythrocyte sedimentation rate; Female; General aspects; Herpes zoster; Herpes Zoster - etiology; Humans; Inflammatory joint diseases; Janus kinase; Janus Kinase 3 - antagonists & inhibitors; Joint diseases; Kinases; Lymphoma; Male; Medical sciences; Medicin och hälsovetenskap; Methotrexate; Methotrexate - administration & dosage; Methotrexate - adverse effects; Middle Aged; Pain; Pharmaceuticals; Pharmacology. Drug treatments; Piperidines - administration & dosage; Piperidines - adverse effects; Protein Kinase Inhibitors - administration & dosage; Protein Kinase Inhibitors - adverse effects; Pyrimidines - administration & dosage; Pyrimidines - adverse effects; Pyrroles - administration & dosage; Pyrroles - adverse effects; Rheumatism; Rheumatoid arthritis; Antineoplastic agent; Immunopathology; Diseases of the osteoarticular system; Autoimmune disease; Inflammatory joint disease; Antifolate; Medicine; Chronic; Antimetabolic; Rheumatoid arthritis; Antirheumatic agent; Methotrexate; Comparative study
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa1310476

In patients with rheumatoid arthritis, tofacitinib was associated with greater reductions in signs and symptoms than methotrexate. Herpes zoster infections and increases in creatinine and in LDL and HDL cholesterol levels were more common with tofacitinib.
Rheumatoid arthritis is a chronic autoimmune disease characterized by inflammation and by joint destruction that leads to substantial disability. The predominant first-line treatment is methotrexate, a nonbiologic agent that is associated with acceptable clinical and functional improvements. Although methotrexate prevents progressive joint damage in some patients,
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concerns have been raised regarding its side effects and safety.
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In one study, discontinuation of methotrexate was reported after 2 years of treatment in one third of the patients and after 5 years of treatment in more than half the patients.
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In combination with methotrexate, biologic disease-modifying antirheumatic drugs (DMARDs), including tumor . . .