Discussion
cancer, RA
CANCER, DISEASE
In this comparative effectiveness study using the TTE framework, we found a modest but statistically significant reduction in disease activity associated with TOF compared with ADA at 3 months and no difference between drugs at 9 months in patients with RA who were b/tsDMARD naive. These results may be generalizable to patients with RA who have not responded to csDMARD therapy and are eligible to initiate their first b/tsDMARD, subject to the limitations of the study. Although the outcomes, time points, and superiority design differ, the small effect size in our analysis is consistent with the previous findings of noninferiority in the American College of Rheumatology response of at least 50% at 6 months for these drugs in a clinical trial.Observational studies are an important supplement to RCTs for assessing whether trial findings can be reproduced in everyday practice in a less restricted patient population and for guiding treatment decisions that occur outside the idealized setting of a trial.Safety signals, although typically rare, are important in connection with ADA and TOF, especially in light of the relatively higher risks of MACE and cancer associated with JAKi therapy compared with TNFi therapy.