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Rheumatology (Oxford). 2020 Mar 1;59(3):568-574. doi: 10.1093/rheumatology/kez324.

Experience with tofacitinib in Canada: patient characteristics and treatment patterns in rheumatoid arthritis over 3 years.

Author information

1
Department of Medicine, Division of Rheumatology, Western University, London, ON, Canada.
2
Department of Medicine, Laval University, Quebec, QC, Canada.
3
Division of Rheumatology, University of Alberta, Edmonton, AB, Canada.
4
Pfizer Inc., Montreal, QC, Canada.
5
Pfizer Inc., Collegeville, PA, USA.
6
Pfizer Inc., Groton, CT, USA.
7
Business Intelligence Consulting, Innomar Strategies Inc., Oakville, ON, Canada.
8
Pfizer Canada, Montreal, QC, Canada.
9
Clinical Research Unit, Institut de Rhumatologie de Montréal, Montreal, QC, Canada.

Abstract

OBJECTIVES:

To describe characteristics, treatment patterns and persistence in patients with RA treated with tofacitinib, an oral Janus kinase inhibitor, in Canadian clinical practice between 1 June 2014 and 31 May 2017.

METHODS:

Data were obtained from the tofacitinib eXel support programme. Baseline demographics and medication history were collected via patient report/special authorization forms; reasons for discontinuation were captured by patient report. Treatment persistence was estimated using Kaplan-Meier methods, with data censored at last follow-up. Cox regression was applied to analyse baseline characteristics associated with treatment discontinuation.

RESULTS:

The number of patients with RA enrolled from 2014 to 2017 was 4276; tofacitinib utilization increased during that period, as did the proportion of biologic (b) DMARD-naïve patients prescribed tofacitinib. Of patients who initiated tofacitinib, 1226/3678 (33.3%) discontinued, mostly from lack of efficacy (35.7%) and adverse events (26.9%). Persistence was 62.7% and 49.6% after 1 and 2 years of treatment, respectively. Prior bDMARD experience predicted increased tofacitinib discontinuation (vs bDMARD-naïve, P < 0.001). Increased retention was associated with older age (56-65 years and >65 years vs ⩽45 years; P < 0.05), and time since diagnosis of 15 to <20 years (vs <5 years; P < 0.01). In bDMARD-naïve, post-1 bDMARD, post-2 bDMARD and post-⩾3 bDMARD patients, median survival was >730, 613, 667 and 592 days, respectively.

CONCLUSION:

Since 2014, tofacitinib use in Canadian patients with RA increased, especially among bDMARD-naïve/post-1 bDMARD patients. Median drug survival was ∼2 years. Likelihood of persistence increased for bDMARD-naïve (vs bDMARD-experienced) patients and those aged ⩾56 (vs ⩽45) years.

KEYWORDS:

drug persistence; patient-support programme; real-world data; rheumatoid arthritis; tofacitinib; utilization

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