Abstract
ObjectiveAnalyze tofacitinib efficacy and safety by background methotrexate (MTX) dose in patients with psoriatic arthritis (PsA).MethodsThis post hoc analysis pooled data from two phase III, double-blind trials (OPAL Broaden, NCT01877668; OPAL Beyond, NCT01882439) including patients receiving tofacitinib 5 or 10 mg twice daily (BID), or placebo, with stable MTX. Efficacy outcomes at month 3 stratified by MTX dose (≤ 15 month 3 stratified by MTX dose vs > 15 mg/week) were American College of Rheumatology (ACR)20/50/70, Health Assessment Questionnaire-Disability Index (HAQ-DI); Psoriasis Area and Severity Index (PASI)50/75; change from baseline in HAQ-DI; physician’s global assessment of PsA (PGA-PsA-visual analog scale [VAS]); patient’s global joint and skin assessment (PGJS-VAS), Leeds Enthesitis Index (LEI); and Dactylitis Severity Score (DSS). Safety assessments included adverse events and laboratory parameters.ResultsFive hundred fifty-six patients received tofacitinib 5 mg BID (n = 186), 10 mg BID (n = 178), or placebo (n = 192), plus MTX (≤ 15 mg/week, n = 371; > 15 mg/week, n = 185). At month 3, tofacitinib efficacy was generally greater than placebo. Patients receiving tofacitinib 5 mg BID demonstrated greater numerical improvements in efficacy outcomes at month 3 with MTX > 15 mg/week vs MTX ≤ 15 mg/week; patients receiving tofacitinib 10 mg BID displayed the opposite. The safety profile was generally consistent between groups; headache was associated with MTX > 15 mg/week; decreased hemoglobin levels were observed in patients receiving tofacitinib 10 mg BID and MTX ≤ 15 mg/week.ConclusionEfficacy of tofacitinib was generally numerically greater than placebo, regardless of MTX dose. Tofacitinib 5 mg BID was generally more efficacious with MTX > 15 mg/week vs ≤ 15 mg/week; the opposite was observed for tofacitinib 10 mg BID. Headache was more frequent with MTX > 15 mg/week.Trial registrationClinicalTrials.gov. Identifier: NCT01877668 (registration: June 14, 2013) and NCT01882439 (registration: June 20, 2013).Key Points• Methotrexate is widely used in the treatment of psoriatic arthritis; however, there are limited data on the impact of varying background methotrexate doses on the efficacy and safety of Janus kinase inhibitors in patients with psoriatic arthritis.• This post hoc analysis assessed the impact of background methotrexate dose (≤ 15 or > 15 mg/week) on tofacitinib efficacy and safety in patients with psoriatic arthritis.• Results indicated that tofacitinib efficacy was generally numerically greater than placebo, regardless of methotrexate dose. Tofacitinib 5 mg twice daily, in combination with a higher dose of background methotrexate, was more efficacious compared with a lower dose of background methotrexate; the opposite was observed for tofacitinib 10 mg twice daily.• Headache was more frequent with the higher methotrexate dose. Data should be interpreted with caution due to the small sample sizes.
Highlights
Psoriatic arthritis (PsA) is a chronic, inflammatory disease, associated with psoriasis [1], and is characterized by enthesitis and dactylitis, axial disease, pain, swelling, and stiffness in the joints [1, 2]
BDMARDs such as etanercept or infliximab [13, 14] have been shown to be more effective in improving efficacy outcomes, such as American College of Rheumatology 20 (ACR20) Response and Minimal Disease Activity [13], or slowing disease progression in patients with PsA [14], compared with MTX monotherapy
ACR20 [15], evidence from the Tight Control in Psoriatic Arthritis (TICOPA) study suggests that ACR20/50, 75% reduction in Psoriasis Area and Severity Index (PASI75), and Psoriatic Arthritis Disease Activity Score responses are improved with higher doses of MTX (> 15 mg/week) [16]
Summary
Psoriatic arthritis (PsA) is a chronic, inflammatory disease, associated with psoriasis [1], and is characterized by enthesitis and dactylitis, axial disease, pain, swelling, and stiffness in the joints [1, 2]. In a post hoc analysis of a phase III trial of tofacitinib in patients with RA, varying the MTX dose used in combination with tofacitinib had minimal effect on key endpoints, such as ACR and the Health Assessment Questionnaire-Disability Index (HAQ-DI) [25]. This post hoc exploratory analysis used data from OPAL Broaden and OPAL Beyond to assess the impact of background MTX dose on the efficacy and safety of tofacitinib in patients with active PsA, who had a previous inadequate response to either csDMARDs or TNFi
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