OBJECTIVES: Oral targeted synthetic disease-modifying anti-rheumatic drugs 
(DMARDs), including the Janus kinase inhibitors tofacitinib and baricitinib, are 
the latest addition to the therapeutic options for rheumatoid arthritis (RA). 
Tofacitinib 5 mg, twice daily, is approved for treatment, with or without 
methotrexate, of moderate to severe active RA in adults not adequately 
responding to, or not tolerating one or more DMARDs. In this narrative review we 
aimed to provide an overview of the real-world evidence for tofacitinib in RA.
METHODS: The literature was reviewed up to March 2018 for studies regarding the 
efficacy and safety of tofacitinib for the treatment of RA. The focus was mainly 
on real-world studies with implications for every day clinical practice.
RESULTS: The efficacy and safety of tofacitinib have been comprehensively 
assessed in a wide programme of randomised controlled trials. Extensive 
observational research on tofacitinib in RA is also ongoing worldwide and a 
substantial body of post-marketing real-world data from clinical practice is 
becoming available. There was a degree of consistency across the real-world 
studies reviewed. Tofacitinib tends to be used as monotherapy more frequently 
than bDMARDS and appears to be effective without background methotrexate. The 
data show a manageable safety profile, with no new safety signals and a 
discontinuation rate from safety issues <10%. Patients initiating tofacitinib 
usually have longer disease duration and have been exposed to longer bDMARDs 
than patients initiating a bDMARD.
CONCLUSIONS: Real-world data are a key component of the evidence supporting the 
effectiveness of this novel drug and are of interest to all stakeholders. 
Treatment persistence and adherence to tofacitinib are good overall and similar 
to those seen for bDMARDs.