Posicionamento sobre o uso de tofacitinibe no algoritmo do Consenso 2012da Sociedade Brasileira de Reumatologia para o tratamento da artrite reumatoide

Abstract

In 2014, tofacitinib, a target-specific, synthetic disease modifying anti rheumatic drug (DMARD) and a selective inhibitor of Janus kinase (JAK) was approved for use in Brazil. This position paper aims to update the recommendations of the Brazilian Society of Rheumatology (SBR) on the treatment of rheumatoid arthritis (RA) in Brazil, specifically regarding the use of target-specific synthetic DMARDs. The method of this recommendation consisted of a literature review of scientific papers held on the Medline database. After this review, a text was produced, answering questions in Pico structure, considering efficacy and safety issues of tofacitinib use for RA treatment in different scenarios (such as first-line treatment after failure with methotrexate [MTX] or other conventional synthetic DMARDs after failure with biological therapy). Based on existing evidence, and considering the available data on efficacy, safety and cost of medications available to treat the disease in Brazil, the RA Commission of SBR, after a process of discussion and voting on proposals, established the following position on the use of tofacitinib for treatment of RA in Brazil: "Tofacitinib, alone or in combination with MTX, is an alternative for RA patients with moderate or high activity after failure of at least two different synthetic DMARDs and one biological DMARD." The level of agreement with this recommendation was 7.5. This position may be reviewed in the coming years, in the face of a greater experience with the use of this medication.

2017 recommendations of the Brazilian Society of Rheumatology for the pharmacological treatment of rheumatoid arthritis

“…The tsDMARD tofacitinib may be prescribed as the second line of treatment, preferably in combination with MTX [41] or in monotherapy in cases of contraindication to MTX. However, because of the higher availability of long-term safety and real-life data for bDMARDs, at present these regimens are preferred as the second-line treatment, and tsDMARDs are considered an alternative to bDMARDs [9]. Although evidence supports the use of the bDMARD rituximab after failure of csDMARD, anti-CD20 is formally approved for treating RA only after TNFi failure and has been used as the third-line treatment in this therapeutic strategy.…”

“…In 2012 and 2013, the RA Committee of the Brazilian Society of Rheumatology (Sociedade Brasileira de Reumatologia-SBR) published recommendations on RA diagnosis and treatment in Brazil to provide support to Brazilian rheumatologists, based upon scientific evidence combined with the experience of a panel of specialists, while safeguarding the necessary autonomy of physicians in choosing among the available therapeutic strategies [5][6][7][8]. In 2015, the recommendations were updated to include the use of target-specific synthetic disease-modifying antirheumatic drugs [9].…”

Tofacitinib, an oral Janus kinase inhibitor, in patients from Brazil with rheumatoid arthritis

“…[ 24 ] Recently, an SBR position paper recommended that tofacitinib as monotherapy or in combination with MTX can be used as an alternative treatment for patients with RA with moderate or high disease activity after failure of at least 2 different csDMARDs and at least 1 bDMARD. [ 25 ] Nevertheless, these recommendations stated that earlier use of tofacitinib may be considered under certain conditions, at the physician's discretion, based on evidence of the efficacy of tofacitinib at different times of treatment.…”