Exploring the Factors Associated With the Discontinuation of Tofacitinib in Patients With Rheumatoid Arthritis: A Retrospective Cohort Study

IF 2 4区医学 Q2 RHEUMATOLOGY

International Journal of Rheumatic Diseases Pub Date : 2025-07-07 DOI:10.1111/1756-185x.70356

Li-Huei Chiang, Chia-Ling Yu, Tzu-Cheng Tsai, Yao-Fan Fang

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引用次数: 0

Abstract

Objectives

Tofacitinib is the first oral targeted synthetic disease-modify anti-rheumatic drug for patients with moderate to severe rheumatoid arthritis. This study aimed to identify the factors associated with the discontinuation of tofacitinib in patients with RA in clinical practice.

Methods

RA patients who received tofacitinib between 2015 and 2020 were included in this observational cohort study. The patients were followed for at least 1 year, ending on December 31, 2022. A tofacitinib non-responder was defined as a patient who required discontinuation or switch to another bDMARD. Conversely, tofacitinib responders were defined as those who could continue to receive tofacitinib without experiencing a loss of efficacy or severe adverse events. Univariate and multivariate Cox regression analyses and Kaplan–Meier survival curve analysis were used to investigate the factors associated with the discontinuation of tofacitinib.

Results

A total of 266 patients were enrolled. The average age of the patients was 57.07 ± 12.07 years, and 99 (37.2%) were tofacitinib non-responders. Univariate analysis revealed that the non-responders had a lower rate of concomitant hydroxychloroquine treatment and higher rates of leflunomide, biological disease-modifying antirheumatic drug (bDMARD), and tumor necrosis factor inhibitor (TNFi) treatment compared to the responders. Cox regression adjusted analysis indicated that prior bDMARD treatment (hazard ratio (HR) = 1.423, 95% confidence interval (CI) = 1.024, 1.976, p = 0.036), prior TNFi treatment (HR = 1.605, 95% CI = 1.165, 2.212, p = 0.004), and prior non-TNFi treatment (HR = 1.326, 95% CI = 1.012, 2.075, p = 0.048) were associated with a higher non-response rate. Moreover, Kaplan–Meier survival curve analysis revealed that the patients with prior bDMARD treatment had a higher non-response rate.

Conclusions

The RA patients who received tofacitinib in this study had a good response rate, and the average non-response rate was around 37% after 2 years of treatment. The main factor associated with an inadequate response to tofacitinib was prior bDMARD treatment. Prior TNFi treatment was the strongest factor associated with a non-response to tofacitinib. Patients with a non-response to tofacitinib may consider bDMARDs with other mechanisms if previous treatment with TNFis was unsuccessful.

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类风湿关节炎患者停用托法替尼的相关因素：一项回顾性队列研究

托法替尼是首个用于中重度类风湿关节炎患者的口服靶向合成疾病修饰抗风湿药物。本研究旨在确定在临床实践中与RA患者停用托法替尼相关的因素。方法将2015 - 2020年接受托法替尼治疗的RA患者纳入观察性队列研究。随访时间至少1年，截止到2022年12月31日。托法替尼无应答者被定义为需要停药或改用另一种bDMARD的患者。相反，托法替尼应答者被定义为那些可以继续接受托法替尼而不会经历疗效丧失或严重不良事件的人。采用单因素和多因素Cox回归分析及Kaplan-Meier生存曲线分析探讨与托法替尼停药相关的因素。结果共纳入266例患者。患者平均年龄为57.07±12.07岁，99例（37.2%）对托法替尼无反应。单因素分析显示，与应答者相比，无应答者同时接受羟氯喹治疗的比例较低，而来氟米特、生物疾病改善抗风湿药物（bDMARD）和肿瘤坏死因子抑制剂（TNFi）治疗的比例较高。Cox回归校正分析显示，既往bDMARD治疗(风险比（HR) = 1.423, 95%可信区间(CI) = 1.024, 1.976, p = 0.036）、既往TNFi治疗（HR = 1.605, 95% CI = 1.165, 2.212, p = 0.004）和既往非TNFi治疗（HR = 1.326, 95% CI = 1.012, 2.075, p = 0.048）与较高的无缓解率相关。此外，Kaplan-Meier生存曲线分析显示，既往接受bDMARD治疗的患者无缓解率更高。结论本研究中接受托法替尼治疗的RA患者有较好的缓解率，治疗2年后平均无缓解率约为37%。与托法替尼反应不足相关的主要因素是先前的bDMARD治疗。先前的TNFi治疗是与托法替尼无反应相关的最强因素。对托法替尼无反应的患者，如果先前使用tnfi治疗不成功，可以考虑使用其他机制的bdmard。

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来源期刊

International Journal of Rheumatic Diseases RHEUMATOLOGY-

CiteScore

3.70

自引率

4.00%

发文量

362

审稿时长

1 months

期刊介绍： The International Journal of Rheumatic Diseases (formerly APLAR Journal of Rheumatology) is the official journal of the Asia Pacific League of Associations for Rheumatology. The Journal accepts original articles on clinical or experimental research pertinent to the rheumatic diseases, work on connective tissue diseases and other immune and allergic disorders. The acceptance criteria for all papers are the quality and originality of the research and its significance to our readership. Except where otherwise stated, manuscripts are peer reviewed by two anonymous reviewers and the Editor.