Methotrexate is the most frequently used first-line antirheumatic drug. We report the
findings of a phase 3 study of monotherapy with tofacitinib, an oral Janus kinase inhibitor,
as compared with methotrexate monotherapy in patients with rheumatoid arthritis
who had not previously received methotrexate or therapeutic doses of methotrexate
We randomly assigned 958 patients to receive 5 mg or 10 mg of tofacitinib twice
daily or methotrexate at a dose that was incrementally increased to 20 mg per week
over 8 weeks; 956 patients received a study drug. The coprimary end points at
month 6 were the mean change from baseline in the van der Heijde modified total
Sharp score (which ranges from 0 to 448, with higher scores indicating greater
structural joint damage) and the proportion of patients with an American College
of Rheumatology (ACR) 70 response (≥70% reduction in the number of both tender
and swollen joints and ≥70% improvement in three of five other criteria: the patient’s
assessment of pain, level of disability, C-reactive protein level or erythrocyte
sedimentation rate, global assessment of disease by the patient, and global assessment
of disease by the physician).