The limitations of this study include an inability
to adjust medication more frequently than
every 3 months, as has been recommended.6
Study participants who have not previously received
methotrexate are not necessarily patients
who have early rheumatoid arthritis (unless the
protocol mandates this criterion for inclusion).
In our trial, the interval between diagnosis of
rheumatoid arthritis and enrollment was less
than 2 years for the majority of patients (65.5%)
and was less than 6 months (median range, 0.7 to
0.8 years) in 40.0% of the patients. Nonetheless,
the mean duration of disease in this trial was
approximately 3 years, so a more focused assessment
of tofacitinib for the treatment of early
rheumatoid arthritis would require a separate
trial.