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

Objectives: The relative efficacy and safety of tofacitinib and peficitinib were assessed in patients with rheumatoid arthritis (RA) with an inadequate response to disease-modifying antirheumatic drugs (DMARDs). Method: 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 peficitinib in combination with DMARDs in patients with an inadequate response to DMARDs. Results: Nine RCTs, including 3836 patients, met the inclusion criteria. Fifteen pairwise comparisons were performed, including six direct comparisons of seven interventions. Tofacitinib 10 mg+methotrexate (MTX) and peficitinib 150 mg+MTX were among the most effective treatments for patients with active RA with an inadequate DMARD response. The efficacy of tofacitinib 10 mg+MTX, peficitinib 150 mg+MTX or tofacitinib 5 mg+MTX tended to be higher than that of adalimumab+MTX. The ranking probability based on the surface under the cumulative ranking curve indicated that tofacitinib 10 mg+MTX had the greatest probability of being the best treatment to achieve the American College of Rheumatology 20 response rate, followed by peficitinib 150 mg+MTX, tofacitinib 5 mg+MTX, adalimumab+MTX, peficitinib 100 mg+MTX, and placebo+MTX. No significant differences were observed in the incidence of serious adverse events after treatment with tofacitinib+MTX, peficitinib+MTX, adalimumab+MTX, or placebo+MTX. Conclusions: In patients with RA with an inadequate response to DMARDs, tofacitinib 10 mg+MTX and peficitinib 150 mg+MTX were the most efficacious interventions and were not associated with a significant risk of serious adverse events.