{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T13:44:05Z","timestamp":1793454245857,"version":"4.5.0"},"reference-count":18,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2020,4,10]],"date-time":"2020-04-10T00:00:00Z","timestamp":1586476800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2020,3,2]]},"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:sec id=\"s1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Multiple biologic and targeted synthetic disease-modifying rheumatic drugs (b\/tsDMARDs) are approved for the management of rheumatoid arthritis (RA), including TNF inhibitors (TNFi), bDMARDs with other modes of action (bDMARD-OMA) and Janus kinase inhibitors (JAKi). Combination of b\/tsDMARDs with conventional synthetic DMARDs (csDMARDs) is recommended, yet monotherapy is common in practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"s2\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare drug maintenance and clinical effectiveness of three alternative treatment options for RA management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"s3\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This observational cohort study was nested within the Swiss RA Registry. TNFi, bDMARD-OMA (abatacept or anti-IL6 agents) or the JAKi tofacitinib (Tofa) initiated in adult RA patients were included. The primary outcome was overall drug retention. We further analysed secondary effectiveness outcomes and whether concomitant csDMARDs modified effectiveness, adjusting for potential confounding factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"s4\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>4023 treatment courses of 2600 patients were included, 1862 on TNFi, 1355 on bDMARD-OMA and 806 on Tofa. TNFi was more frequently used as a first b\/tsDMARDs, at a younger age and with shorter disease duration. Overall drug maintenance was significantly lower with TNFi compared with Tofa [HR 1.29 (95% CI 1.14 to 1.47)], but similar between bDMARD-OMA and Tofa [HR 1.09 (95% CI 0.96 to 1.24)]. TNFi maintenance was decreased when prescribed without concomitant csDMARDs [HR: 1.27 (95% CI 1.08 to 1.49)], while no difference was observed for bDMARD-OMA or Tofa maintenance with respect to concomitant csDMARDs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"s5\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Tofa drug maintenance was comparable with bDMARDs-OMA and somewhat higher than TNFi. Concomitant csDMARDs appear to be required for optimal effectiveness of TNFi, but not for bDMARD-OMA or Tofa.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rmdopen-2020-001174","type":"journal-article","created":{"date-parts":[[2020,5,8]],"date-time":"2020-05-08T06:05:15Z","timestamp":1588917915000},"page":"e001174","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":67,"title":["Comparative effectiveness of antitumour necrosis factor agents, biologics with an alternative mode of action and tofacitinib in an observational cohort of patients with rheumatoid arthritis in Switzerland"],"prefix":"10.1136","volume":"6","author":[{"given":"A","family":"Finckh","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Specialties, University Hospitals Geneva, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Tellenbach","sequence":"additional","affiliation":[{"name":"Statistics Group, SCQM Foundation, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L","family":"Herzog","sequence":"additional","affiliation":[{"name":"Statistics Group, SCQM Foundation, Zurich, Switzerland"},{"name":"Zurich University of Applied Sciences, Institute of Data Analysis and Process Design (IDP), Winterthur, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Scherer","sequence":"additional","affiliation":[{"name":"Statistics Group, SCQM Foundation, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B","family":"Moeller","sequence":"additional","affiliation":[{"name":"Inselspital und Universit\u00e4tsspital Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Ciurea","sequence":"additional","affiliation":[{"name":"University Hospital Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I","family":"von Muehlenen","sequence":"additional","affiliation":[{"name":"Private Practice, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Gabay","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Specialties, University Hospitals Geneva, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Kyburz","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, University Hospital Basel, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L","family":"Brulhart","sequence":"additional","affiliation":[{"name":"Rheumatology, R\u00e9seau hospitalier neuch\u00e2telois, La Chaux-de-Fonds,Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Kantonsspital Aarau, Aarau, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Hasler","sequence":"additional","affiliation":[{"name":"Kantonsspital Aarau, Aarau, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Zufferey","sequence":"additional","affiliation":[{"name":"Centres Hospitaliers Universitaires Vaudois, Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,5,7]]},"reference":[{"key":"2025090312430245000_6.1.e001174.1","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1136\/annrheumdis-2018-eular.3312","article-title":"FRI0110 The impact of seropositivity on the effectiveness of abatacept versus TNF inhibitors in rheumatoid arthritis. Real life data from several european registries (THE PAN-ABA STUDY)","volume":"77","author":"Courvoisier","year":"2018","journal-title":"Ann Rheum Dis"},{"key":"2025090312430245000_6.1.e001174.2","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2017-212845"},{"key":"2025090312430245000_6.1.e001174.3","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kev019"},{"key":"2025090312430245000_6.1.e001174.4","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2015.21.5.409"},{"key":"2025090312430245000_6.1.e001174.5","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/39.5.542"},{"key":"2025090312430245000_6.1.e001174.6","doi-asserted-by":"publisher","DOI":"10.1002\/art.21570"},{"key":"2025090312430245000_6.1.e001174.7","doi-asserted-by":"publisher","DOI":"10.2307\/2291635"},{"key":"2025090312430245000_6.1.e001174.8","doi-asserted-by":"publisher","DOI":"10.1002\/art.37711"},{"key":"2025090312430245000_6.1.e001174.9","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60250-0"},{"key":"2025090312430245000_6.1.e001174.10","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/S0140-6736(17)31618-5","article-title":"Efficacy and safety of tofacitinib monotherapy, tofacitinib with methotrexate, and adalimumab with methotrexate in patients with rheumatoid arthritis (ORAL Strategy): a phase 3b\/4, double-blind, head-to-head, randomised controlled trial","volume":"390","author":"Fleischmann","year":"2017","journal-title":"Lancet"},{"key":"2025090312430245000_6.1.e001174.11","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1056\/NEJMoa1608345","article-title":"Baricitinib versus placebo or adalimumab in rheumatoid arthritis","volume":"376","author":"Taylor","year":"2017","journal-title":"N Engl J Med"},{"key":"2025090312430245000_6.1.e001174.12","doi-asserted-by":"crossref","first-page":"1788","DOI":"10.1002\/art.41032","article-title":"Upadacitinib versus placebo or adalimumab in patients with rheumatoid arthritis and an inadequate response to methotrexate: results of a phase iii, double-blind, randomized controlled trial","volume":"71","author":"Fleischmann","year":"2019","journal-title":"Arthritis Rheumatol"},{"key":"2025090312430245000_6.1.e001174.13","doi-asserted-by":"crossref","first-page":"8417249","DOI":"10.1155\/2017\/8417249","article-title":"Tofacitinib versus biologic treatments in moderate-to-severe rheumatoid arthritis patients who have had an inadequate response to nonbiologic DMARDs: systematic literature review and network meta-analysis","volume":"2017","author":"Bergrath","year":"2017","journal-title":"Int J Rheumatol"},{"key":"2025090312430245000_6.1.e001174.14","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1186\/s13075-018-1539-6","article-title":"Effectiveness and safety of tofacitinib in rheumatoid arthritis: a cohort study","volume":"20","author":"Machado","year":"2018","journal-title":"Arthritis Res Ther"},{"key":"2025090312430245000_6.1.e001174.15","article-title":"Real-world data from a post-approval safety surveillance study of tofacitinib vs biologic DMARDs and conventional synthetic DMARDs: five-year results from a US-based rheumatoid arthritis registry [abstract]","volume":"70","author":"Kremer","year":"2018","journal-title":"Arthritis Rheumatol"},{"key":"2025090312430245000_6.1.e001174.16","doi-asserted-by":"crossref","unstructured":"Smolen JS , Landew\u00e9 RBM , Bijlsma JWJ , et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis 2020 doi: 10.1136\/annrheumdis-2019-216655.","DOI":"10.1136\/annrheumdis-2019-216655"},{"key":"2025090312430245000_6.1.e001174.17","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2015-207760"},{"key":"2025090312430245000_6.1.e001174.18","doi-asserted-by":"crossref","unstructured":"Reed GW , Gerber RA , Shan Y , et al. TNFI and TOFACITINIB monotherapy and comparative effectiveness in clinical practice: results from Corrona registry. Ann Rheum Dis 2017;76:60 (OP00022).","DOI":"10.1136\/annrheumdis-2017-eular.1939"}],"container-title":["RMD Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rmdopen-2020-001174","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T19:43:07Z","timestamp":1756928587000},"score":1,"resource":{"primary":{"URL":"https:\/\/rmdopen.bmj.com\/lookup\/doi\/10.1136\/rmdopen-2020-001174"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5]]},"references-count":18,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,5,7]]},"published-print":{"date-parts":[[2020,5]]}},"alternative-id":["10.1136\/rmdopen-2020-001174"],"URL":"https:\/\/doi.org\/10.1136\/rmdopen-2020-001174","relation":{},"ISSN":["2056-5933"],"issn-type":[{"value":"2056-5933","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5]]}}}