A systematic review and meta-analysis of nine studies involving 24,643 patients with rheumatoid arthritis found that tofacitinib was associated with higher ACR20 response rates and greater improvement in pain and physical function compared with adalimumab, while DAS28-CRP improvement and overall adverse-event rates were similar between therapies. However, the findings showed substantial heterogeneity, and the apparent ACR20 advantage was largely driven by higher-dose tofacitinib regimens greater than 5 mg twice daily. The researchers also noted that the analysis was not designed to assess long-term safety outcomes associated with Janus kinase inhibitors, including cardiovascular events and thrombosis.