Tofacitinib versus Methotrexate in Rheumatoid Arthritis

In patients with rheumatoid arthritis, tofacitinib was associated with greater reductions in signs and symptoms than methotrexate. Herpes zoster infections and increases in creatinine and in LDL and HDL cholesterol levels were more common with tofacitinib. Rheumatoid arthritis is a chronic autoimmune disease characterized by inflammation and by joint destruction that leads to substantial disability. The predominant first-line treatment is methotrexate, a nonbiologic agent that is associated with acceptable clinical and functional improvements. Although methotrexate prevents progressive joint damage in some patients, 1 – 3 concerns have been raised regarding its side effects and safety. 4 – 8 In one study, discontinuation of methotrexate was reported after 2 years of treatment in one third of the patients and after 5 years of treatment in more than half the patients. 9 In combination with methotrexate, biologic disease-modifying antirheumatic drugs (DMARDs), including tumor . . .