COMPARISON OF THE EFFICACY AND SAFETY OF TOFACITINIB AND APREMILAST IN PATIENTS WITH ACTIVE PSORIATIC ARTHRITIS: A BAYESIAN NETWORK META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

초록

Background: The therapeutic options for psoriatic arthritis (PsA) include conventional disease-modifying antirheumatic drugs and biologics. However, an unmet need exists for PsA therapies owing to drug intolerance, non-responsiveness, and therapeutic resistance. Therefore, there is a need for additional treatment options with novel mechanisms of action. Tofacitinib is an orally administered JAK inhibitor and apremilast is a novel oral phosphodiesterase 4 inhibitor that regulates inflammatory mediators. Objectives: The aim of this study is to assess the relative efficacy and safety of tofacitinib and apremilast at different doses in patients with active PsA. Methods: We conducted a Bayesian network meta-analysis to combine evidence from randomized controlled trials (RCTs) for examination of the efficacy and safety of tofacitinib 10 mg, tofacitinib 5 mg, apremilast 30 mg, and apremilast 20 mg in PsA. Results: Eight RCTs including 3,086 patients met the inclusion criteria. There were 10 pairwise comparisons including 6 direct comparisons of 5 interventions. All the interventions achieved a significant American College of Rheumatology 20 (ACR20) response compared with placebo. Tofacitinib 10 mg and apremilast 30 mg were among the most effective treatments for active PsA, followed by tofacitinib 5 mg, and apremilast 20 mg. The ranking probability based on the surface under the cumulative ranking curve (SUCRA) indicated that tofacitinib 10 mg had the highest probability of being the best treatment in terms of the ACR20 response rate (SUCRA = 0.785), followed by apremilast 30 mg (SUCRA = 0.670), tofacitinib 5 mg (SUCRA = 0.596), apremilast 20 mg (SUCRA = 0.448), and placebo (SUCRA = 0.001). No significant differences were observed in the incidence of serious adverse events after treatment with tofacitinib 10 mg, apremilast 30 mg, tofacitinib 5 mg, apremilast 20 mg, or placebo. Conclusion: In active PsA patients, tofacitinib 10 mg and apremilast 30 mg were the most efficacious interventions and were not associated with a significant risk of serious adverse events.