A post-hoc analysis of phase 3 clinical data has demonstrated that patients with psoriatic arthritis (PsA) can safely switch directly from adalimumab to tofacitinib without requiring a washout period, while maintaining therapeutic effectiveness.
Safety and Efficacy Findings
The research, published in Arthritis Research & Therapy, analyzed data from 180 adult PsA patients, with approximately half transitioning from adalimumab (40 mg every two weeks) to tofacitinib (5 mg twice daily) during the long-term extension study. The remaining participants received continuous tofacitinib treatment throughout both study phases.
"This work is an extension of previous work on the effect of tofacitinib in patients with psoriatic arthritis," explained Dr. Dafna D. Gladman from the University of Toronto's Department of Medicine. "The purpose was to determine the efficacy and safety outcomes of patients who were originally treated with tofacitinib and those who were originally treated with adalimumab, but later switched to tofacitinib."
Clinical Response Metrics
The study evaluated multiple efficacy measures, including:
- ACR20/50/70 responses
- Psoriasis Area Severity Index
- Psoriatic Arthritis Disease Activity Score
- Health Assessment Questionnaire Disability Index
Both patient groups demonstrated comparable efficacy during the phase 3 study, with responses maintained through three months of the long-term extension phase. Notably, patients who showed positive responses after switching to tofacitinib were predominantly those who had responded well during the initial study period.
Safety Profile Analysis
The safety assessment revealed comparable rates of:
- Treatment-emergent adverse events
- Serious adverse events
- Serious infections
These rates remained consistent across both treatment groups throughout the study duration, confirming an acceptable safety profile for the direct transition strategy.
Clinical Implications
"This analysis demonstrated that both patients who continued on tofacitinib and those who switched from adalimumab to tofacitinib demonstrated similar efficacy, and the safety profile was maintained," Dr. Gladman noted. This finding provides valuable guidance for clinicians, suggesting they can confidently transition PsA patients between these medications without compromising treatment outcomes or safety.
The study addresses an important gap in clinical knowledge, as direct switching between different classes of PsA medications has not been extensively studied. These findings offer new flexibility in treatment options for healthcare providers managing patients with psoriatic arthritis.
