Evaluating Tofacitinib in Psoriatic Arthritis: Monotherapy vs Combination Therapy

The CorEvitas registry found that tofacitinib—started as monotherapy or together with conventional synthetic DMARDs—produced comparable real-world improvements in disease activity and patient-reported outcomes in adults with psoriatic arthritis.

This registry analysis included 141 adults with rheumatologist-diagnosed PsA who started tofacitinib—66 as monotherapy and 75 with concomitant oral small molecules—with follow-up at 6 ± 3 months. Baseline descriptors showed more monotherapy initiators were OSM treatment–naïve and reported worse baseline PROs. The report detailed demographics, prior biologic exposure, dose distribution, and month-6 endpoints including disease activity scores (cDAPSA, DAPSA, mPASDAS), skin involvement (BSA), joint counts, PROs (pain, fatigue, HAQ-DI, WPAI), safety, and treatment persistence.

Both monotherapy and combination groups demonstrated clinically meaningful improvements by 6 months; monotherapy initiators had larger numerical changes (cDAPSA −8.2 vs −4.4; DAPSA −10.7 vs −4.9). After adjustment for baseline covariates (age, sex, disease duration, prior b/tsDMARD and OSM exposure, and baseline outcome values), between-group differences in least-squares means were not statistically significant. The appropriate interpretation is that monotherapy is a viable option with comparable effectiveness to combination therapy in routine practice, while recognizing numerical trends that did not retain significance after adjustment.

Safety reporting was similar across approaches, with no significant differences in adverse-event reporting during registry follow-up. Discontinuation by 6 ± 3 months affected roughly one-quarter of patients (≈26–29% by group). Among discontinuers, a higher proportion of monotherapy starters escalated to a biologic or targeted synthetic DMARD (73.7% vs 42.1%). Overall retention on tofacitinib at 6 months was comparable (≈71–75%), but the greater likelihood of escalation among monotherapy initiators has implications for monitoring and operational planning.

Higher baseline disease activity and worse baseline PROs were associated with larger absolute improvements; predictor patterns differed between groups—monotherapy initiators were more often OSM-naïve and had higher baseline pain and work-impairment scores, correlating with greater numeric gains in WPAI and activity impairment. These baseline characteristics can inform treatment selection: consider patient disease burden, prior exposure, and treatment goals when choosing monotherapy versus combination, and incorporate these signals into shared decision-making and monitoring to anticipate need for escalation.

Key Takeaways:

• What’s new — Tofacitinib monotherapy delivers comparable real-world improvements in disease activity and PROs to combination therapy in the CorEvitas registry.
• Who’s affected — Patients eligible for JAK inhibitor therapy and clinicians weighing monotherapy versus csDMARD co‑prescription; monotherapy may be reasonable for those who are OSM‑naïve or who prefer an oral-only regimen.
• What changes next — Consider monotherapy as a practical option for selected patients while maintaining standard safety monitoring and readiness to switch to biologic/tsDMARD therapy if disease control is inadequate.