Non-MTX-csDMARDs versus MTX in combination with tofacitinib: a post hoc analysis

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by synovial inflammation leading to both cartilage destruction and bone erosions. Targeted therapies have changed management and outcomes of RA patients. JAK inhibitors (tofacitinib) are a new class of targeted synthetic Disease-Modifying-Anti Rheumatic-Drug (tsDMARD) approved as RA treatment, in monotherapy or in combination. Some data indicate that tofacitinib is more efficient in combination with methotrexate (MTX) than in monotherapy. When MTX cannot be used, others conventional synthetic Disease-Modifying-Anti Rheumatic-Drug (called non-MTX csDMARD) such as leflunomide or sulfasalazine can be proposed in combination with tofacitinib but their effectiveness in association is not established. Recent post hoc analysis has been realized for baricitinib in association with csDMARDs but not for tofacitinib.