Tofacitinib Versus Tumor Necrosis Factor Blockers For Rheumatoid Arthritis:A Systematic Review

Objective:To evaluate the efficacy and safety of tofacitinib versus tumor necrosis factor blockers in the treatment of rheumatoid arthritis(RA).Method:We search the Pubmed?embase?cochrane?CBMdisc?Wangfang database and CNKI(all up to November 4,2018)to discover and select the randomized controlled trial(RCT)about tofacitinib versus tumor necrosis factor blockers treating RA.The participants were patients with RA.The primary outcomes were ACR20?ACR50 and ACR70.The secondary outcomes were HAQ-DI?DAS28-4ESR?Pt GA and Pain.Two reviewers independently identified the include trial,extracted data and evaluated the risk of bias of literatures.We use the Review manager software to analyse data.The result of dichotomous data were expressed by the relative risk(RR)and 95%confidence interval(CI).The result of continuous data were expressed by the mean difference(MD)and 95%CI.Result: Five literatures were include in this systematic review.The five literatures contain 4 RCTs which were all about tofacitinib versus adalimumab in the treatment of RA.The sample size of the RCTs ranged from 163-762 with a total enrollment of 1920 patients with RA.The overall risk of bias was low in 1 literatures and high in 4 literatures.Result analysis:1.The primary outcomes:ACR20?ACR50 and ACR70.For ACR50 outcome in patients who were treated for 3months,tofacitinib 5mg group was significantly superior to adalimumab group,RR was 1.51(1.13,2.01).For ACR70 outcome in patients who were treated for 6months,tofacitinib 10 mg group was significantly superior to adalimumab group,RR was 2.42(1.45,4.06).For primary outcomes at other treatment time points,there was no statistical difference between adalimumab group and tofacitinib group,no matter tofacitinib 5mg group or tofacitinib 10 mg group.2.The secondary outcomes HAQ-DI?DAS28-4ESR?Pt GA and Pain: there was no statistical difference between tofacitinib group and adalimumab group.3.Safety outcomes: For incidence rate of adverse events?serious adverse events and discontinuing due to adverse events,there was no statistical difference between tofacitinib group and adalimumab group.Conclusions: For efficacy,tofacitinib was equivalent to adalimumab in most cases.Tofacitinib was superior to adalimumab in efficacy sometimes.For safety outcomes,there was no statistical difference between tofacitinib group and adalimumab group.