{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T12:29:37Z","timestamp":1793449777898,"version":"4.5.0"},"reference-count":27,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T00:00:00Z","timestamp":1754956800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2025,9]]},"abstract":"ABSTRACT<\/jats:title>\n \n Objective<\/jats:title>\n \n To evaluate patterns in disease\u2010modifying antirheumatic drugs (\n DMARDs<\/jats:styled-content>\n ) initiations between 2001 and 2021 among adults with Rheumatoid Arthritis (\n RA<\/jats:styled-content>\n ) in the United States\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This retrospective cohort study used a\n US<\/jats:styled-content>\n commercial claims database (2001\u20132021) to identify patients (\u2265\u200918\u2009years) with\n RA<\/jats:styled-content>\n newly initiating a\n DMARD<\/jats:styled-content>\n . We calculated the annual proportion of initiations for 22\n DMARDs<\/jats:styled-content>\n , categorized as conventional synthetic (\n csDMARDs<\/jats:styled-content>\n ), biologic (\n bDMARDs<\/jats:styled-content>\n ), and targeted synthetic (\n tsDMARDs<\/jats:styled-content>\n ). Secondary analyses examined trends in first\u2010line non\u2010\n csDMARD<\/jats:styled-content>\n initiation and biosimilar uptake.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n We identified 407,728\n DMARD<\/jats:styled-content>\n initiation episodes among 229,365 unique patients with\n RA<\/jats:styled-content>\n (median age: 50\u2009years [\n IQR<\/jats:styled-content>\n ], 44\u201358\u2009years; 79.4% female). There were shifts in\n DMARD<\/jats:styled-content>\n initiations, with\n csDMARD<\/jats:styled-content>\n initiation declining from 79.9% of initiations in 2001 to 54.7% by 2021 (\n p<\/jats:italic>\n \u2009<\u20090.001 for trend). Meanwhile,\n bDMARDs<\/jats:styled-content>\n and\n tsDMARDs<\/jats:styled-content>\n initiations increased from 20.3% in 2001 to 33.1% in 2021 (\n p<\/jats:italic>\n \u2009<\u20090.001) and from 0.1% in 2012 to 12.2% in 2021 (\n p<\/jats:italic>\n \u2009=\u20090.171), respectively. Methotrexate remained the most initiated\n DMARD<\/jats:styled-content>\n over the 21\u2010year study period, albeit declining from 28.7% to 15.0% of initiations over the study period (\n p<\/jats:italic>\n \u2009<\u20090.001). Adalimumab was the most frequently initiated\n bDMARD<\/jats:styled-content>\n (13.3% in 2003 and 12.2% in 2021;\n p<\/jats:italic>\n \u2009=\u20090.05). Among\n tsDMARDs<\/jats:styled-content>\n , tofacitinib initiation peaked at 8.9% in 2019 and declined to 4.4% in 2021, while upadacitinib initiation increased from 1.2% to 7.6% during the same period (\n p<\/jats:italic>\n \u2009<\u20090.001). For secondary analyses, adalimumab was the predominant first\u2010line b\/\n tsDMARD<\/jats:styled-content>\n initiated (>\u200940%). Biosimilar uptake stayed below 1%.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n Expanded\n DMARD<\/jats:styled-content>\n options over the last two decades have led to decreased\n csDMARD<\/jats:styled-content>\n initiations and increased b\/\n tsDMARD<\/jats:styled-content>\n initiations, reflecting patient\u2010 and system\u2010level factors.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/phar.70051","type":"journal-article","created":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T08:55:43Z","timestamp":1754988943000},"page":"578-586","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Trends in Initiation of Disease\u2010Modifying Antirheumatic Drugs for Rheumatoid Arthritis Among Commercially Insured Adults in the United States, 2001\u20132021"],"prefix":"10.1002","volume":"45","author":[{"given":"Lydia Y.","family":"Lee","sequence":"first","affiliation":[{"name":"Center for Health Outcomes, Policy & Economics Rutgers Ernest Mario School of Pharmacy and Rutgers School of Public Health Piscataway New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey A.","family":"Sparks","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priyanka","family":"Yalamanchili","sequence":"additional","affiliation":[{"name":"Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research Rutgers University New Brunswick New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel B.","family":"Horton","sequence":"additional","affiliation":[{"name":"Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research Rutgers University New Brunswick New Jersey USA"},{"name":"Department of Pediatrics, Rutgers Robert Wood Johnson Medical School Rutgers University New Brunswick New Jersey USA"},{"name":"Department of Biostatistics and Epidemiology, Rutgers School of Public Health Rutgers University Piscataway New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeba M.","family":"Khan","sequence":"additional","affiliation":[{"name":"Center for Health Outcomes, Policy & Economics Rutgers Ernest Mario School of Pharmacy and Rutgers School of Public Health Piscataway New Jersey USA"},{"name":"Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy Rutgers University Piscataway New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Barone","sequence":"additional","affiliation":[{"name":"Center for Health Outcomes, Policy & Economics Rutgers Ernest Mario School of Pharmacy and Rutgers School of Public Health Piscataway New Jersey USA"},{"name":"Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy Rutgers University Piscataway New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chintan V.","family":"Dave","sequence":"additional","affiliation":[{"name":"Center for Health Outcomes, Policy & Economics Rutgers Ernest Mario School of Pharmacy and Rutgers School of Public Health Piscataway New Jersey USA"},{"name":"Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research Rutgers University New Brunswick New Jersey USA"},{"name":"Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy Rutgers University Piscataway New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,12]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2020.08.008"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10153289"},{"key":"e_1_2_8_4_1","volume-title":"What are the New Drugs for Rheumatoid Arthritis (RA)?","author":"Judith S.","year":"2023"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.3390\/cells10112857"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.24596"},{"key":"e_1_2_8_7_1","article-title":"DMARD Disruption, Disease Flare, and Prolonged Symptom Duration Aafter Acute COVID\u201019 Among Participants With Rheumatic Disease: A Prospective Study","volume":"55","author":"Di Iorio M.","year":"2022","journal-title":"Medical Preprint 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L.Keisler\u2010Starkey \u201cHealth Insurance Coverage in the United States: 2021 \u201d(2023) https:\/\/www.census.gov\/library\/publications\/2022\/demo\/p60\u2010278.html."},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41584-022-00755-x"}],"container-title":["Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/phar.70051","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T17:05:00Z","timestamp":1761066300000},"score":1,"resource":{"primary":{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/10.1002\/phar.70051"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,12]]},"references-count":27,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["10.1002\/phar.70051"],"URL":"https:\/\/doi.org\/10.1002\/phar.70051","archive":["Portico"],"relation":{},"ISSN":["0277-0008","1875-9114"],"issn-type":[{"value":"0277-0008","type":"print"},{"value":"1875-9114","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,12]]},"assertion":[{"value":"2024-11-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}