OBJECTIVES: The relative efficacy and safety of tofacitinib and baricitinib were 
assessed in patients with rheumatoid arthritis (RA) with an inadequate response 
to disease-modifying anti-rheumatic drugs (DMARDs) or biologics.
METHODS: We performed a Bayesian network meta-analysis to combine direct and 
indirect evidence from randomized controlled trials (RCTs) to examine the 
efficacy and safety of tofacitinib and baricitinib in combination with DMARDs in 
RA patients with an inadequate DMARD or biologic response.
RESULTS: Twelve RCTs including 5883 patients met the inclusion criteria. There 
were 15 pairwise comparisons including 10 direct comparisons of 6 interventions. 
Tofacitinib 10 mg + methotrexate (MTX) and baricitinib 4 mg + MTX were among the 
most effective treatments for active RA with an inadequate DMARD or biologic 
response, followed by baricitinib 2 mg + MTX, tofacitinib 5 mg + MTX, and 
adalimumab + MTX. The ranking probability based on the surface under the 
cumulative ranking curve (SUCRA) indicated that tofacitinib 10 mg + MTX had the 
highest probability of being the best treatment to achieve the ACR20 response 
rate (SUCRA = 0.865), followed by baricitinib 4 mg + MTX (SUCRA = 0.774), 
baricitinib 2 mg + MTX (SUCRA = 0.552), tofacitinib 5 mg + MTX (SUCRA = 0.512), 
adalimumab + MTX (SUCRA = 0.297), and placebo + MTX (SUCRA <0.001). No 
significant differences were observed in the incidence of serious adverse events 
after treatment with tofacitinib + MTX, baricitinib + MTX, adalimumab + MTX, or 
placebo + MTX.
CONCLUSIONS: In RA patients with an inadequate response to DMARDs or biologics, 
tofacitinib 10 mg + MTX and baricitinib 4 mg + MTX were the most efficacious 
interventions and were not associated with a significant risk of serious adverse 
events.