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Direct switching from adalimumab to tofacitinib in PsA: Results from OPAL Broaden and Balance
By Ella Dixon
|
Treatment switching in PsA may be required to achieve low disease activity or remission, as patients can experience inadequate responses to first-line and subsequent therapies.1 However, treatment switching can involve a washout period to avoid overlap of immunomodulatory effects, potentially resulting in increased PsA symptoms.1 Gladman et al.1 assessed the efficacy and safety of switching to tofacitinib after adalimumab (ADA), compared with continuing tofacitinib in patients with PsA in a post hoc analysis of the 12-month, phase III randomized, double-blind OPAL Broaden (NCT01877668) and 36-month, open-label long-term extension OPAL Balance (NCT01976364) trials. Overall, 180 patients were included in the analysis (ADA→tofacitinib 5 mg BID, n = 91; continuing tofacitinib 5 mg BID, n = 89). Their findings were recently published in Arthritis Research & Therapy.1 |
| Key learnings |
| Clinical outcomes, including ACR20/50/70 and PASI75 responses, were comparable between groups, although ACR70 was numerically higher in the ADA→tofacitinib group vs the tofacitinib continuing group. |
| Disease control was maintained in patients switching from ADA to tofacitinib without a washout period, and no increase in TEAEs was seen after switching. |
| Similar rates of TEAEs and SAEs were observed in both groups, with a higher rate of TEAEs in the first 3 months of the study. No significant safety concerns arose from switching therapies directly, and opportunistic infections, herpes zoster, and malignancies were rare. |
| These findings demonstrate that tofacitinib efficacy and safety were similar in patients who were switched directly from ADA to tofacitinib and those continuing tofacitinib, suggesting that patients with PsA can be switched from ADA directly to tofacitinib without any washout period. |
Abbreviations: ACR20/50/70, ≥20%, ≥50%, and ≥70% improvements in American College of Rheumatology response criteria; ADA, adalimumab; BID, twice daily; PASI75; ≥70% improvement in Psoriasis Area and Severity Index scores from baseline; PsA, psoriatic arthritis; SAE, serious adverse event; TEAE, treatment-emergent adverse event.
- Gladman DD, Nash P, Mease PJ, et al. Efficacy and safety of tofacitinib in an open-label, long-term extension study in patients with psoriatic arthritis who received adalimumab or tofacitinib in a phase 3 randomized controlled study: a post hoc analysis. Arthritis Res Ther. 2024;26(1):218. DOI: 10.1186/s13075-024-03442-2
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