Reduced Use of Tofacitinib for US Veterans With RA, Cardiovascular Comorbidities

The release of safety data regarding advanced therapies for rheumatoid arthritis (RA) significantly impacted prescribing patterns among physicians treating US veterans, according to a study in Arthritis Care & Research.

Findings from the Oral Rheumatoid Arthritis Surveillance trial were released in January 2021 and showed the use of tofacitinib, a nonselective Janus kinase inhibitor (JAKi), was linked to a higher risk of major adverse cardiac events and cancers in adults over age 50. The US Food and Drug Administration added a box warning on all JAKis to reflect these risks and updated its usage indication to active RA with an inadequate response or intolerance to tumor necrosis factor inhibitors (TNFis).

The recent study published in Arthritis Care & Research investigated the impact of the safety data on the characteristics of patients initiating and discontinuing advanced RA therapies by comparing data from April 2019 through September 2022, with a focus on prescriptions in two 664-day periods before and after January 2021. Researchers analyzed data from US veterans with RA who initiated a TNFi, a non-TNFi biologic, or a JAKi. They specifically assessed whether changes in patient characteristics for those using tofacitinib where different than changes observed for other therapies.

In total, 2111 patients were treated with tofacitinib before January 2021, and 1664 patients used this treatment after January 2021. The authors noted a decrease in mean age between the 2 cohorts (64.1 vs 63.0 years). The proportion of cardiovascular comorbidities also decreased in the cohort of patients treated with tofacitinib after January 2021 (P<.01). This change in the proportion of comorbidities was significantly different for tofacitinib users compared with patients initiating TNFi or non-TNFi biologics.

Regarding discontinuation, the likelihood of discontinuation was higher for tofacitinib than TNFi, with a hazard ratio of 1.18 (95% CI, 1.10-1.26; P<.001). The authors noted that the presence of cardiovascular comorbidities was associated with a higher rate of tofacitinib discontinuation compared with other treatments (P<.05).

“Recent safety data significantly affected prescribing practices for advanced therapies,” the authors concluded, “with a reduction in JAKi initiation and an increase in JAKi discontinuation among older patients and those at high cardiovascular risk.”