Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Dec;43(12):3625-3637.
doi: 10.1007/s10067-024-07161-6. Epub 2024 Oct 11.

Incidence and risk factors of discontinuation of tofacitinib and biologic disease-modifying anti-rheumatic drugs among patients with rheumatoid arthritis: A population-based cohort study

Po-Cheng Shih  1   2 , Po-Cheng Hung  3 , Pui-Ying Leong  4   5   6   7 , Jui-Ning Hsu  3   5 , Chieh-Chun Yang  3 , James Cheng Chung Wei  8   9   10   11   12 , Hsin-Hua Chen  13   14
Affiliations

Incidence and risk factors of discontinuation of tofacitinib and biologic disease-modifying anti-rheumatic drugs among patients with rheumatoid arthritis: A population-based cohort study

Po-Cheng Shih et al. Clin Rheumatol. 2024 Dec.

Abstract

To investigate the incidence of the discontinuation among tofacitinib and biologic disease-modifying anti-rheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA). This retrospective population-based cohort study included 5,008 RA patients who initiated treatment with either tofacitinib or bDMARDs (etanercept, adalimumab, golimumab, tocilizumab, or abatacept) between January 1, 2014, and December 31, 2020. We conducted Cox proportional hazards regression and subsequent time-dependent regression to assess the risk of drug discontinuation, with adjustments for potential variables. The highest drug discontinuation rate was observed with etanercept (43.27%), while the lowest was with tofacitinib (21.8%). Tofacitinib was associated with a significantly lower risk of discontinuation compared to etanercept (HR: 0.67, 95% CI: 0.57-0.80) and other bDMARDs. Higher steroid dosage and the presence of concomitant connective tissue diseases were significant risk factors for drug discontinuation. Conversely, the use of methotrexate was associated with a reduced risk of discontinuation. Tofacitinib demonstrated a lower risk of drug discontinuation compared to TNFi, with the risk factors for discontinuation including higher steroid dosage and concomitant connective tissue diseases. The study highlights the importance of considering several potential risk factors in drug discontinuation. Key Points • Non-TNFi biologic agents demonstrated better drug retention than TNFi among patients diagnosed with rheumatoid arthritis, with tofacitinib showing the lowest discontinuation rate (21.8%), underscoring its potential for superior drug retention in rheumatoid arthritis management. • Several factors were associated with drug discontinuation: higher steroid dosage and concomitant connective tissue diseases were linked to a higher discontinuation rate, whereas the concomitant use of methotrexate was associated with a lower risk of discontinuation.

Keywords: Biological agents; Drug discontinuation; Drug persistence; Rheumatoid arthritis; TNF inhibitors; Tofacitinib.

PubMed Disclaimer

Conflict of interest statement

Compliance with ethical standards. Ethics approval: This study was approved by Institutional Review Board of Chung Shan Medical University Hospital. (Approval number: CS19159). Disclosures: None

References

    1. Radu A-F, Bungau SG (2021) Management of rheumatoid arthritis: an overview. Cells 10(11):2857 - DOI - PubMed - PMC
    1. Movahedi M, Choquette D, Coupal L, Cesta A, Li X, Keystone EC et al (2023) Discontinuation of tofacitinib and TNF inhibitors in patients with rheumatoid arthritis: analysis of pooled data from two registries in Canada. BMJ Open 13(3):e063198 - DOI - PubMed - PMC
    1. Nevins I, Den Broeder AA, Groenen PSM, De Buck PDM, Reimann F, Bos R et al (2024) POS0624 real-world effectiveness of tofacitinib in monotherapy or in combination with csdmards in subgroups of patients with rheumatoid arthritis: a collaboration between dutch registries (tofadudap study). Ann Rheum Dis 83(Suppl 1):775–776
    1. Aymon R, Mongin D, Bergstra SA, Choquette D, Codreanu C, De Cock D et al (2024) Evaluation of discontinuation for adverse events of JAK inhibitors and bDMARDs in an international collaboration of rheumatoid arthritis registers (the ‘JAK-pot’study). Ann Rheum Dis 83(4):421–8 - DOI - PubMed
    1. Ebina K, Etani Y, Maeda Y, Okita Y, Hirao M, Yamamoto W et al (2023) Drug retention of biologics and Janus kinase inhibitors in patients with rheumatoid arthritis: the ANSWER cohort study. RMD Open 9(3):e003160 - DOI - PubMed - PMC

MeSH terms

LinkOut - more resources