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.