Comparison of the efficacy and safety of tofacitinib and mavrilimumab in patients with active rheumatoid arthritis: A Bayesian network meta-analysis of randomized controlled trials

Objectives: The relative efficacy and safety of tofacitinib and mavrilimumab were assessed in patients with rheumatoid arthritis (RA) presenting an inadequate response to disease-modifying antirheumatic drugs (DMARDs). Materials and methods: We performed a Bayesian network meta-analysis combining direct and indirect evidence from randomized controlled trials (RCTs) to examine the efficacy and safety of tofacitinib and mavrilimumab combined with DMARDs in patients with an inadequate response to DMARDs. Results: In total, 8 RCTs with 2,965 patients met inclusion criteria. 21 pairwise comparisons were performed, including 12 direct comparisons of 7 interventions. In patients with active RA and an inadequate DMARD response, mavrilimumab 150 mg+methotrexate (MTX) and mavrilimumab 100 mg+MTX were the most effective treatments. Compared with placebo+MTX, all tofacitinib and mavrilimumab doses, except mavrilimumab 50 mg+MTX, achieved significant ACR20 responses. The ranking probability based on the surface under the cumulative ranking curve indicated that mavrilimumab 150 mg+MTX had the highest probability for best treatment outcome in terms of the ACR20 response rate, followed by mavrilimumab 100 mg+MTX, tofacitinib 10 mg+MTX, tofacitinib 5 mg+MTX, mavrilimumab 30 mg+MTX, mavrilimumab 50 mg+MTX, and placebo+MTX. No significant differences were noted in the incidence of serious adverse events (SAEs) after tofacitinib+MTX, mavrilimumab+MTX, or placebo+MTX. Conclusion: In patients with RA showing inadequate DMARD response, mavrilimumab 150 mg+MTX and mavrilimumab 100 mg+MTX, followed by tofacitinib 10 mg+MTX and tofacitinib 5 mg+MTX, were the most efficacious interventions and were not associated with a significant risk of SAEs.