The effect of tofacitinib on residual pain in patients with rheumatoid arthritis and psoriatic arthritis

Objective: Post hoc analysis of pooled data from 9 randomised controlled trials to assess the effect of tofacitinib (oral Janus kinase inhibitor for treatment of rheumatoid arthritis [RA] and psoriatic arthritis [PsA]) on residual pain in patients with RA or PsA with abrogated inflammation. Methods: Patients who received ≥1 dose of tofacitinib 5 mg twice daily (BID), adalimumab or placebo with/without background conventional synthetic disease-modifying antirheumatic drugs and had abrogated inflammation (swollen joint count [SJC]=0 and C reactive protein [CRP]<6 mg/L) after 3 months’ therapy were included. Assessments included Patient’s Assessment of Arthritis Pain at Month 3 (Visual Analogue Scale [VAS] 0–100 mm). Scores were summarised descriptively; treatment comparisons assessed by Bayesian network meta analyses (BNMA). Results: From the total RA/PsA population, 14.9% (382/2568), 17.1% (118/691) and 5.5% (50/909) of patients receiving tofacitinib, adalimumab and placebo, respectively, had abrogated inflammation after 3 months’ therapy. RA/PsA patients with abrogated inflammation receiving tofacitinib/adalimumab had higher baseline CRP versus placebo; RA patients receiving tofacitinib/adalimumab had lower SJC and longer disease duration versus placebo. Median residual pain (VAS) at Month 3 was 17.0, 19.0 and 33.5 in RA patients treated with tofacitinib, adalimumab or placebo, and 24.0, 21.0 and 27.0 in PsA patients, respectively. Residual pain reductions with tofacitinib/adalimumab versus placebo were less prominent in PsA versus RA patients, with no significant differences between tofacitinib/adalimumab, per BNMA. Conclusion: Patients with RA/PsA with abrogated inflammation receiving tofacitinib/adalimumab had greater residual pain reduction versus placebo at Month 3. Results were similar between tofacitinib/adalimumab