Comparison of several alternative uses of targeted antirheumatic drugs in monotherapy for early rheumatoid arthritis

Abstract

Objective: to evaluate the efficacy of tocilizumab (TCZ) versus tofacitinib (TOFA) in patients with severe and moderate rheumatoid arthritis (RA) who have not previously received methotrexate (MTX). Material and methods. A systematic search for studies dealing with the evaluation of the efficacy of TCZ and TOFA was made in accordance with the provisions of the instruction «Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)». Indirect comparison of two Function and ORAL Start randomized clinical trials was done, as described by Н.C. Buchera. The trials were comparable in their design and in the baseline characteristics of patients. The efficiency of pharmacotherapy for early RA was evaluated based on the ACR20/50/70 response rates in MTX-naive patients from three endpoints. Results. The indirect comparison of TOFA and TCZ (A MTX general control) after 52 weeks of treatment in MT-naive patients with severe and moderate RA indicated that the use of TOFA 5 mg twice daily and TCZ 8 mg/kg showed no difference in ACR20, ACR50, and ACR70 response rates. Nevertheless, there was a tendency to the greater efficiency of TOFA (5 mg twice daily) than that of TCZ (8 mg/kg). The indirect comparison of TOFA (10 mg twice daily) and TCZ (8 mg/kg) established that TCZ therapy was associated with the lower response rate for ACR50 (by 37%): the relative risk (RR) was 0.63; 95% confidence interval (CI), 0.44–0.90 and for ACR70 (by 51%): RR, 0.49; 95% CI, 0.29–0.83 as compared with TOFA therapy. Conclusion. The indirect comparisons confirmed that monotherapy with TOFA (10 mg twice daily) produced a more pronounced antiinflammatory effect than that with TCZ in MTX-naive patients with early severe and moderate RA of less than one year's duration. There were no statistically significant differences in ACR response rates between the TOFA (5 mg twice daily) and TCZ (8 mg/kg) groups.