Comparison of the efficacy and safety of tofacitinib and filgotinib in patients with active rheumatoid arthritis: a Bayesian network meta-analysis of randomized controlled trials

Abstract

Objective We compared the efficacy and safety of tofacitinib and filgotinib in patients with rheumatoid arthritis (RA) showing inadequate response to conventional synthetic (cs) or biologic (b) disease-modifying anti-rheumatic drugs (DMARDs). Methods We performed a Bayesian network meta-analysis to combine direct and indirect evidence from randomized controlled trials (RCTs) to examine the efficacy and safety of tofacitinib and filgotinib in combination with methotrexate (MTX) in patients with RA exhibiting inadequate cs- or bDMARD response. Results Nine RCTs consisting of 5466 patients met the inclusion criteria. We obtained 15 pairwise comparisons, including 11 direct comparisons from 6 interventions. Tofacitinib 10 & x202f;mg & x202f;+ MTX and filgotinib 200 & x202f;mg & x202f;+ MTX were among the most effective treatments for active RA showing an inadequate cs- or bDMARD response, followed by tofacitinib 5 & x202f;mg & x202f;+ MTX, filgotinib 100 & x202f;mg & x202f;+ MTX, and adalimumab & x202f;+ MTX. Ranking probability based on the surface under the cumulative ranking curve (SUCRA) indicated that tofacitinib 10 & x202f;mg & x202f;+ MTX and filgotinib 200 & x202f;mg & x202f;+ MTX showed the highest probability of being the best treatment options in terms of ACR20 response rate (SUCRA & x202f;= 0.898, 0.782), followed by tofacitinib 5 & x202f;mg & x202f;+ MTX (SUCRA & x202f;= 0.602), filgotinib 100 & x202f;mg & x202f;+ MTX (SUCRA & x202f;= 0.359), adalimumab & x202f;+ MTX (SUCRA & x202f;= 0.358), and placebo & x202f;+ MTX (SUCRA & x202f;= 0.001). No significant differences were observed in the incidence of serious adverse events after treatment with tofacitinib & x202f;+ MTX, filgotinib & x202f;+ MTX, adalimumab & x202f;+ MTX, or placebo & x202f;+ MTX. Conclusion In patients with RA exhibiting an inadequate response to cs- or bDMARDs, tofacitinib 10 & x202f;mg & x202f;+ MTX and filgotinib 200 & x202f;mg & x202f;+ MTX were the most efficacious interventions and risks of serious adverse events did not differ between tofacitinib and filgotinib groups.