Tofacitinib demonstrates favorable efficacy but an increased risk of herpes zoster in elderly patients with rheumatoid arthritis: a retrospective cohort analysis.

OBJECTIVE

To evaluate the efficacy of tofacitinib in elderly patients with rheumatoid arthritis (RA) and analyze herpes zoster risk factors.

METHODS

A retrospective analysis included elderly RA patients from January 2022 to June 2024. Patients were assigned to a tofacitinib group (n=62, tofacitinib + methotrexate) or a conventional disease-modifying antirheumatic drugs (DMARDs) group (n=58, methotrexate + leflunomide). Clinical efficacy, inflammatory markers, American College of Rheumatology (ACR) response rates, joint function, herpes zoster incidence, and other adverse reactions were assessed.

RESULTS

After treatment, the tofacitinib group had lower Disease Activity Score 28-erythrocyte sedimentation rate (ESR) scores than the conventional DMARDs group (P<0.05). ESR, C-reactive protein, and rheumatoid factor levels were significantly lower (P<0.05), while ACR20/50/70 response rates were significantly higher in the tofacitinib group (P<0.05). Health Assessment Questionnaire Disability Index scores, morning stiffness duration, and pain scores were also lower (P<0.05). Herpes zoster incidence was higher in the tofacitinib group (12.90%) than that in the conventional DMARDs group (3.45%; P<0.05). Multivariable logistic regression identified tofacitinib use, age ≥75 years, glucocorticoid use, reduced lymphocyte count, and prior herpes zoster as independent risk factors (P<0.05).

CONCLUSIONS

Tofacitinib is efficacious in elderly RA patients, improving disease activity and joint function, but increases herpes zoster risk. High-risk patients require monitoring; prophylactic vaccination may be considered.