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

Objectives. The relative efficacy and safety of tofacitinib and baricitinib were assessed in patients with rheumatoid arthritis (RA) with an inadequate response to disease-modifying anti-rheumatic drugs (DMARDs) or biologics. Methods. 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 baricitinib in combination with DMARDs in RA patients with an inadequate DMARD or biologic response. Results. Twelve RCTs including 5883 patients met the inclusion criteria. There were 15 pairwise comparisons including 10 direct comparisons of 6 interventions. Tofacitinib 10mg+ methotrexate (MTX) and baricitinib 4mg+ MTX were among the most effective treatments for active RA with an inadequate DMARD or biologic response, followed by baricitinib 2mg+ MTX, tofacitinib 5mg+ MTX, and adalimumab + MTX. The ranking probability based on the surface under the cumulative ranking curve (SUCRA) indicated that tofacitinib 10mg + MTX had the highest probability of being the best treatment to achieve the ACR20 response rate (SUCRA= 0.865), followed by baricitinib 4mg + MTX (SUCRA = 0.774), baricitinib 2mg+ MTX (SUCRA= 0.552), tofacitinib 5mg+ MTX (SUCRA= 0.512), adalimumab+ MTX (SUCRA= 0.297), and placebo+ MTX (SUCRA < 0.001). No significant differences were observed in the incidence of serious adverse events after treatment with tofacitinib+ MTX, baricitinib+ MTX, adalimumab+ MTX, or placebo+ MTX. Conclusions. In RA patients with an inadequate response to DMARDs or biologics, tofacitinib 10mg+ MTX and baricitinib 4mg+ MTX were the most efficacious interventions and were not associated with a significant risk of serious adverse events.