Tofacitinib After One TNF Inhibitor Cost-Effective for RA, Study Finds

An economic model predicted that a treatment strategy with Xeljanz (tofacitinib, Pfizer) after a single tumor necrosis factor (TNF) inhibitor for rheumatoid arthritis (RA) is more cost-effective compared with tofacitinib following 2 TNF inhibitors, according to research presented in a poster at AMCP.

The study’s aim was to evaluate and compare the economic impact of the oral Janus kinase inhibitor tofacitinib 5 mg twice daily after one TNF inhibitor (Humira [adalimumab] or Enbrel [entanercept]) or both TNF inhibitors in patients with moderate to severe RA who failed first-line therapy with methotrexate, from the US perspective.

For the study, researchers used a decision-tree economic model to evaluate costs over 2 years in 1321 patients. Treatment response was modeled as American College of Rheumatology (ACR) 20/50/70 response. ACR response rates at 6-month intervals were derived from US Prescribing Information. The researchers assumed that 75% of patients switched therapy after an adverse event/lack of response. Cost inputs included drug monitoring, drug administration, and treatment of minor/serious adverse events. The study endpoints included total costs, costs per member per month (PMPM), and costs per ACR20 responder.

Based on ACR20 switch criteria and 100% monotherapy rate for all treatments, the study showed total 2-year costs were lower for tofacitinib after adalimumab or entanercept ($129,240,497 and $130,214,370, respectively) versus adalimumab and entanercept or entanercept and adalimumab ($133,731,160 and $133,665,292, respectively). Costs PMPM were also lower for tofacitinib after one TNF inhibitor ($5.39 for adalimumab and $5.43 for entanercept) compared with 2 TNF inhibitors ($5.57 each for adalimumab and entanercept or entanercept and adalimumab). The costs per ACR20 responders were lowest among patients who received tofacitinib after entanercept ($126,817) and highest for patients who received tofacitinib following treatment with adalimumab and entanercept ($142,967). When monotherapy was adjusted to 50% for all treatments, the researchers observed similar trends for 2-year total costs, costs per PMPM, and cost per ACR20 responder. The authors also noted differences with rebates of up to 20% for adalimumab and entanercept and 0% for tofacitinib. Similar trends were seen when ACR50 switch criteria was used.

Twice-daily tofacitinib was initially approved by the FDA in 2012. In February 2016, the FDA approved a once-daily extended-release formulation (11 mg).

This study was supported by funding from Pfizer.

Claxton L, Taylor M, Jenks M, Soonasra A, Gerber R. An economic evaluation of tofacitinib (Xeljanz) treatment after one or two TNF inhibitors in rheumatoid arthritis from the United States perspective. J Manag Care Spec Pharm. 2016;22(4 suppl):S105.