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Long-term safety of tofacitinib for the treatment of rheumatoid arthritis up to 8.5 years: integrated analysis of data from the global clinical trials

Identifieur interne : 000875 ( Main/Exploration ); précédent : 000874; suivant : 000876

Long-term safety of tofacitinib for the treatment of rheumatoid arthritis up to 8.5 years: integrated analysis of data from the global clinical trials

Auteurs : Stanley B. Cohen [États-Unis] ; Yoshiya Tanaka [Japon] ; Xavier Mariette [France] ; Jeffrey R. Curtis [États-Unis] ; Eun Bong Lee [Corée du Sud] ; Peter Nash [Australie] ; Kevin L. Winthrop [États-Unis] ; Christina Charles-Schoeman [États-Unis] ; Krishan Thirunavukkarasu [Australie] ; Ryan Demasi [États-Unis] ; Jamie Geier [États-Unis] ; Kenneth Kwok [États-Unis] ; Lisy Wang [États-Unis] ; Richard Riese [États-Unis] ; Jürgen Wollenhaupt [Allemagne]

Source :

RBID : PMC:5530353

Descripteurs français

English descriptors

Abstract

Objectives

Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA). We report an integrated safety summary of tofacitinib from two phase I, nine phase II, six phase III and two long-term extension studies in adult patients with active RA.

Methods

Data were pooled for all tofacitinib-treated patients (data cut-off: 31 March 2015). Incidence rates (IRs; patients with event/100 patient-years) and 95% CIs are reported for adverse events (AEs) of interest.

Results

6194 patients received tofacitinib for a total 19 406 patient-years' exposure; median exposure was 3.4 patient-years. IR (95% CI) for serious AEs was 9.4 (9.0 to 9.9); IR for serious infections was 2.7 (2.5 to 3.0). IR for (all) herpes zoster was 3.9 (3.6 to 4.2); IR for disseminated or multidermatomal herpes zoster was 0.3 (0.2 to 0.4). IR for opportunistic infections (excluding tuberculosis) was 0.3 (0.2 to 0.4) and was 0.2 (0.1 to 0.3) for tuberculosis. IR for malignancies (excluding non-melanoma skin cancer (NMSC)) was 0.9 (0.8 to 1.0); NMSC IR was 0.6 (0.5 to 0.7). IR for gastrointestinal perforations was 0.1 (0.1 to 0.2). Analysis of IR for serious infections, herpes zoster and malignancies by 6-month intervals did not reveal any notable increase in IR with longer-duration tofacitinib exposure.

Conclusion

This analysis of tofacitinib exposure up to 8.5 years allowed estimation of safety events with improved precision versus previous tofacitinib reports. AEs were generally stable over time; no new safety signals were observed compared with previous tofacitinib reports.

Trial registration numbers

NCT01262118, NCT01484561, NCT00147498, NCT00413660, NCT00550446, NCT00603512, NCT00687193, NCT01164579, NCT00976599, NCT01059864, NCT01359150, NCT00960440, NCT00847613, NCT00814307, NCT00856544, NCT00853385, NCT01039688, NCT00413699, NCT00661661; Results.


Url:
DOI: 10.1136/annrheumdis-2016-210457
PubMed: 28143815
PubMed Central: 5530353


Affiliations:


Links toward previous steps (curation, corpus...)


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<country xml:lang="fr">États-Unis</country>
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<term>Infection (immunologie)</term>
<term>Infection (épidémiologie)</term>
<term>Infection (étiologie)</term>
<term>Infections opportunistes (immunologie)</term>
<term>Infections opportunistes (épidémiologie)</term>
<term>Infections opportunistes (étiologie)</term>
<term>Inhibiteurs de protéines kinases (effets indésirables)</term>
<term>Jeune adulte</term>
<term>Mâle</term>
<term>Pipéridines (effets indésirables)</term>
<term>Polyarthrite rhumatoïde (traitement médicamenteux)</term>
<term>Pyrimidines (effets indésirables)</term>
<term>Pyrroles (effets indésirables)</term>
<term>Sujet immunodéprimé</term>
<term>Sujet âgé</term>
<term>Sujet âgé de 80 ans ou plus</term>
<term>Tuberculose (immunologie)</term>
<term>Tuberculose (épidémiologie)</term>
<term>Tuberculose (étiologie)</term>
<term>Tumeurs (immunologie)</term>
<term>Tumeurs (épidémiologie)</term>
<term>Tumeurs (étiologie)</term>
<term>Zona (immunologie)</term>
<term>Zona (épidémiologie)</term>
<term>Zona (étiologie)</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en">
<term>Piperidines</term>
<term>Protein Kinase Inhibitors</term>
<term>Pyrimidines</term>
<term>Pyrroles</term>
</keywords>
<keywords scheme="MESH" qualifier="drug therapy" xml:lang="en">
<term>Arthritis, Rheumatoid</term>
</keywords>
<keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr">
<term>Inhibiteurs de protéines kinases</term>
<term>Pipéridines</term>
<term>Pyrimidines</term>
<term>Pyrroles</term>
</keywords>
<keywords scheme="MESH" qualifier="epidemiology" xml:lang="en">
<term>Herpes Zoster</term>
<term>Infection</term>
<term>Neoplasms</term>
<term>Opportunistic Infections</term>
<term>Tuberculosis</term>
</keywords>
<keywords scheme="MESH" qualifier="etiology" xml:lang="en">
<term>Herpes Zoster</term>
<term>Infection</term>
<term>Neoplasms</term>
<term>Opportunistic Infections</term>
<term>Tuberculosis</term>
</keywords>
<keywords scheme="MESH" qualifier="immunologie" xml:lang="fr">
<term>Infection</term>
<term>Infections opportunistes</term>
<term>Tuberculose</term>
<term>Tumeurs</term>
<term>Zona</term>
</keywords>
<keywords scheme="MESH" qualifier="immunology" xml:lang="en">
<term>Herpes Zoster</term>
<term>Infection</term>
<term>Neoplasms</term>
<term>Opportunistic Infections</term>
<term>Tuberculosis</term>
</keywords>
<keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr">
<term>Polyarthrite rhumatoïde</term>
</keywords>
<keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr">
<term>Infection</term>
<term>Infections opportunistes</term>
<term>Tuberculose</term>
<term>Tumeurs</term>
<term>Zona</term>
</keywords>
<keywords scheme="MESH" qualifier="étiologie" xml:lang="fr">
<term>Infection</term>
<term>Infections opportunistes</term>
<term>Tuberculose</term>
<term>Tumeurs</term>
<term>Zona</term>
</keywords>
<keywords scheme="MESH" xml:lang="en">
<term>Adolescent</term>
<term>Adult</term>
<term>Aged</term>
<term>Aged, 80 and over</term>
<term>Clinical Trials as Topic</term>
<term>Female</term>
<term>Humans</term>
<term>Immunocompromised Host</term>
<term>Incidence</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Time Factors</term>
<term>Young Adult</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr">
<term>Adolescent</term>
<term>Adulte</term>
<term>Adulte d'âge moyen</term>
<term>Essais cliniques comme sujet</term>
<term>Facteurs temps</term>
<term>Femelle</term>
<term>Humains</term>
<term>Incidence</term>
<term>Jeune adulte</term>
<term>Mâle</term>
<term>Sujet immunodéprimé</term>
<term>Sujet âgé</term>
<term>Sujet âgé de 80 ans ou plus</term>
</keywords>
</textClass>
</profileDesc>
</teiHeader>
<front>
<div type="abstract" xml:lang="en">
<sec>
<title>Objectives</title>
<p>Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA). We report an integrated safety summary of tofacitinib from two phase I, nine phase II, six phase III and two long-term extension studies in adult patients with active RA.</p>
</sec>
<sec>
<title>Methods</title>
<p>Data were pooled for all tofacitinib-treated patients (data cut-off: 31 March 2015). Incidence rates (IRs; patients with event/100 patient-years) and 95% CIs are reported for adverse events (AEs) of interest.</p>
</sec>
<sec>
<title>Results</title>
<p>6194 patients received tofacitinib for a total 19 406 patient-years' exposure; median exposure was 3.4 patient-years. IR (95% CI) for serious AEs was 9.4 (9.0 to 9.9); IR for serious infections was 2.7 (2.5 to 3.0). IR for (all) herpes zoster was 3.9 (3.6 to 4.2); IR for disseminated or multidermatomal herpes zoster was 0.3 (0.2 to 0.4). IR for opportunistic infections (excluding tuberculosis) was 0.3 (0.2 to 0.4) and was 0.2 (0.1 to 0.3) for tuberculosis. IR for malignancies (excluding non-melanoma skin cancer (NMSC)) was 0.9 (0.8 to 1.0); NMSC IR was 0.6 (0.5 to 0.7). IR for gastrointestinal perforations was 0.1 (0.1 to 0.2). Analysis of IR for serious infections, herpes zoster and malignancies by 6-month intervals did not reveal any notable increase in IR with longer-duration tofacitinib exposure.</p>
</sec>
<sec>
<title>Conclusion</title>
<p>This analysis of tofacitinib exposure up to 8.5 years allowed estimation of safety events with improved precision versus previous tofacitinib reports. AEs were generally stable over time; no new safety signals were observed compared with previous tofacitinib reports.</p>
</sec>
<sec>
<title>Trial registration numbers</title>
<p>
<ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/study/NCT01262118?term=NCT01262118&rank=1">NCT01262118</ext-link>
,
<ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/study/NCT01484561?term=NCT01484561&rank=1">NCT01484561</ext-link>
,
<ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT00147498?term=NCT00147498&rank=1">NCT00147498</ext-link>
,
<ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/study/NCT00413660?term=NCT00413660&rank=1">NCT00413660</ext-link>
,
<ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT00550446?term=NCT00550446&rank=1">NCT00550446</ext-link>
,
<ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT00603512?term=NCT00603512&rank=1">NCT00603512</ext-link>
,
<ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT00687193?term=NCT00687193&rank=1">NCT00687193</ext-link>
,
<ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT01164579?term=NCT01164579&rank=1">NCT01164579</ext-link>
,
<ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT00976599?term=NCT00976599&rank=1">NCT00976599</ext-link>
,
<ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT01059864?term=NCT01059864&rank=1">NCT01059864</ext-link>
,
<ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT01359150?term=NCT01359150&rank=1">NCT01359150</ext-link>
,
<ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT00960440?term=NCT00960440&rank=1">NCT00960440</ext-link>
,
<ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT00847613?term=NCT00847613&rank=1">NCT00847613</ext-link>
,
<ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT00814307?term=NCT00814307&rank=1">NCT00814307</ext-link>
,
<ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT00856544?term=NCT00856544&rank=1">NCT00856544</ext-link>
,
<ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/results/NCT00853385?term=NCT00853385&rank=1">NCT00853385</ext-link>
,
<ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT01039688?term=NCT01039688&rank=1">NCT01039688</ext-link>
,
<ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT00413699?term=NCT00413699&rank=1">NCT00413699</ext-link>
,
<ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/study/NCT00661661?term=NCT00661661&rank=1">NCT00661661</ext-link>
; Results.</p>
</sec>
</div>
</front>
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<name sortKey="Strangfeld, A" uniqKey="Strangfeld A">A Strangfeld</name>
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<author>
<name sortKey="Listing, J" uniqKey="Listing J">J Listing</name>
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<author>
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</author>
<author>
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<author>
<name sortKey="Black, Rj" uniqKey="Black R">RJ Black</name>
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<name sortKey="Moreland, Lw" uniqKey="Moreland L">LW Moreland</name>
</author>
<author>
<name sortKey="Westhovens, R" uniqKey="Westhovens R">R Westhovens</name>
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</analytic>
</biblStruct>
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<author>
<name sortKey="Bykerk, Vp" uniqKey="Bykerk V">VP Bykerk</name>
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<author>
<name sortKey="Cush, J" uniqKey="Cush J">J Cush</name>
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<author>
<name sortKey="Winthrop, K" uniqKey="Winthrop K">K Winthrop</name>
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<name sortKey="Wolfe, F" uniqKey="Wolfe F">F Wolfe</name>
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<name sortKey="Gonzalez Gay, Md" uniqKey="Gonzalez Gay M">MD Gonzalez-Gay</name>
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<author>
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<name sortKey="Xie, F" uniqKey="Xie F">F Xie</name>
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<li>Allemagne</li>
<li>Australie</li>
<li>Corée du Sud</li>
<li>France</li>
<li>Japon</li>
<li>États-Unis</li>
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<name sortKey="Curtis, Jeffrey R" sort="Curtis, Jeffrey R" uniqKey="Curtis J" first="Jeffrey R" last="Curtis">Jeffrey R. Curtis</name>
<name sortKey="Demasi, Ryan" sort="Demasi, Ryan" uniqKey="Demasi R" first="Ryan" last="Demasi">Ryan Demasi</name>
<name sortKey="Geier, Jamie" sort="Geier, Jamie" uniqKey="Geier J" first="Jamie" last="Geier">Jamie Geier</name>
<name sortKey="Kwok, Kenneth" sort="Kwok, Kenneth" uniqKey="Kwok K" first="Kenneth" last="Kwok">Kenneth Kwok</name>
<name sortKey="Riese, Richard" sort="Riese, Richard" uniqKey="Riese R" first="Richard" last="Riese">Richard Riese</name>
<name sortKey="Wang, Lisy" sort="Wang, Lisy" uniqKey="Wang L" first="Lisy" last="Wang">Lisy Wang</name>
<name sortKey="Winthrop, Kevin L" sort="Winthrop, Kevin L" uniqKey="Winthrop K" first="Kevin L" last="Winthrop">Kevin L. Winthrop</name>
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<name sortKey="Tanaka, Yoshiya" sort="Tanaka, Yoshiya" uniqKey="Tanaka Y" first="Yoshiya" last="Tanaka">Yoshiya Tanaka</name>
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<name sortKey="Mariette, Xavier" sort="Mariette, Xavier" uniqKey="Mariette X" first="Xavier" last="Mariette">Xavier Mariette</name>
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<country name="Corée du Sud">
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<name sortKey="Lee, Eun Bong" sort="Lee, Eun Bong" uniqKey="Lee E" first="Eun Bong" last="Lee">Eun Bong Lee</name>
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<name sortKey="Thirunavukkarasu, Krishan" sort="Thirunavukkarasu, Krishan" uniqKey="Thirunavukkarasu K" first="Krishan" last="Thirunavukkarasu">Krishan Thirunavukkarasu</name>
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