For difficult-to-treat RA, the better STRATEGY is to ADD-ON Tofacitinib to MTX, rather than to replace it.
Sure, Tofacitinib can be used alone (Oral SOLO), but it is only adequately effective in mild-to-moderate cases. If the RA is mild/moderate, why does one need to resort to expensive Tofacitinib in the first instance? Often, "MTX intolerance" is a relative luxury symptom.
AbbVie's Upadacitinib (ABT-494) Meets All Primary and Ranked Secondary Endpoints in Phase 3 Study in Rheumatoid Arthritis
When thrombosis was an issue with Baricitinib holding up FDA approval, and 1 of 2 deaths with Upadacitinib is due to pulmonary embolism, it's more likely to be related than not.