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Research ArticleRheumatoid Arthritis

Tofacitinib Persistence in Patients with Rheumatoid Arthritis: A Retrospective Cohort Study

Anat Fisher, Marie Hudson, Robert W. Platt and Colin R. Dormuth for the Canadian Network for Observational Drug Effect Studies (CNODES) Investigators
The Journal of Rheumatology January 2021, 48 (1) 16-24; DOI: https://doi.org/10.3899/jrheum.191252
Anat Fisher
1A. Fisher, Research Associate, MD, PhD, C.R. Dormuth, Associate Professor, ScD, Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia;
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  • ORCID record for Anat Fisher
  • For correspondence: anat.fisher@ti.ubc.ca
Marie Hudson
2M. Hudson, Associate Professor, MD, Division of Rheumatology, Jewish General Hospital and Lady Davis Institute, Department of Medicine, McGill University, Montreal, Québec;
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Robert W. Platt
3R.W. Platt, Professor, PhD, Departments of Pediatrics and of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.
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Colin R. Dormuth
1A. Fisher, Research Associate, MD, PhD, C.R. Dormuth, Associate Professor, ScD, Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia;
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Abstract

Objective. To compare medication persistence of tofacitinib with persistence of injectable biological disease-modifying antirheumatic drugs (bDMARD) in patients with rheumatoid arthritis (RA).

Methods. We performed a retrospective new-user cohort study of patients with RA in the IBM MarketScan Research Databases. New users of tofacitinib or bDMARD were identified between November 2012 and December 2016. Persistence, in number of years, was the time between treatment initiation and the earliest occurrence of discontinuation or switching from the medication prescribed at cohort entry. Persistence of tofacitinib was compared with bDMARD persistence using Cox proportional hazards regression with adjustment for high-dimensional propensity scores. Similar methods were used for an analysis of post first-line therapy in patients who switched to tofacitinib from a bDMARD.

Results. New tofacitinib users (n = 1031) were 56 years of age, on average, and 82% were women. New bDMARD users (n = 17,803) were 53 years of age, on average, and 78% were women. New tofacitinib users had shorter medication persistence (median 0.81 yrs) compared to bDMARD patients (1.02 yrs). After adjustment, the HR for discontinuation of tofacitinib compared with bDMARD was 1.14 (95% CI 1.05–1.25). Patients who switched to tofacitinib from a bDMARD had longer persistence than patients who switched to a bDMARD (adjusted HR for discontinuation 0.90, 95% CI 0.83–0.97).

Conclusion. Further research is warranted to understand the reasons for discontinuation of tofacitinib despite its ease of administration and to understand the observed differences between switchers and new users.

Key Indexing Terms:
  • biological therapy
  • Janus kinase inhibitors
  • medication adherence
  • rheumatoid arthritis
  • Accepted for publication April 16, 2020.
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The Journal of Rheumatology
Vol. 48, Issue 1
1 Jan 2021
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Tofacitinib Persistence in Patients with Rheumatoid Arthritis: A Retrospective Cohort Study
Anat Fisher, Marie Hudson, Robert W. Platt, Colin R. Dormuth
The Journal of Rheumatology Jan 2021, 48 (1) 16-24; DOI: 10.3899/jrheum.191252

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Tofacitinib Persistence in Patients with Rheumatoid Arthritis: A Retrospective Cohort Study
Anat Fisher, Marie Hudson, Robert W. Platt, Colin R. Dormuth
The Journal of Rheumatology Jan 2021, 48 (1) 16-24; DOI: 10.3899/jrheum.191252
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Keywords

BIOLOGICAL THERAPY
Janus kinase inhibitors
MEDICATION ADHERENCE
RHEUMATOID ARTHRITIS

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