{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T06:44:38Z","timestamp":1777877078047,"version":"3.51.4"},"reference-count":30,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:00:00Z","timestamp":1771804800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:00:00Z","timestamp":1771804800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100010101","name":"Taichung Veterans General Hospital","doi-asserted-by":"publisher","award":["TCVGH-1129101D"],"award-info":[{"award-number":["TCVGH-1129101D"]}],"id":[{"id":"10.13039\/501100010101","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010101","name":"Taichung Veterans General Hospital","doi-asserted-by":"publisher","award":["TCVGH-1139101D"],"award-info":[{"award-number":["TCVGH-1139101D"]}],"id":[{"id":"10.13039\/501100010101","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010101","name":"Taichung Veterans General Hospital","doi-asserted-by":"publisher","award":["TCVGH-T1127803"],"award-info":[{"award-number":["TCVGH-T1127803"]}],"id":[{"id":"10.13039\/501100010101","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Therapeutic Advances in Musculoskeletal"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Data regarding malignancy risk amongst rheumatoid arthritis (RA) patients using biological and targeted synthetic disease-modifying antirheumatic drugs (b\/tsDMARDs) was conflicting, and real-world Taiwanese data was lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To compare the malignancy risk and to investigate factors associated with malignancies amongst RA patients initiating b\/tsDMARDs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Nationwide, population-based, retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study using the Taiwan National Health Insurance Research Database from 2001 to 2020. Adult patients with newly diagnosed, biologic-na\u00efve RA were included if they initiated b\/tsDMARDs, and those with prior malignancies were excluded. The primary outcome was the first diagnosis of malignancies after b\/tsDMARD initiation. Time-dependent Cox proportional hazards models were performed to evaluate malignancy risk across different b\/tsDMARDs and to identify independent risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 8732 adult RA patients were included. Over both 5-year and extended 18-year follow-up periods, there was no statistically significant difference in malignancy risk amongst the four treatment groups (tumour necrosis factor inhibitors (TNFis), tocilizumab, abatacept and tsDMARDs). Independent associated factors included male gender, older age at b\/tsDMARD initiation, chronic lung diseases including chronic obstructive pulmonary disease and higher-dose corticosteroid prescription. Use of conventional DMARDs and more frequent ambulatory follow-up were associated with a lower risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>In this Taiwanese nationwide RA cohort, b\/tsDMARD class demonstrated no difference in malignancy risk within 5\u2009years after their initiation. Clinicians should instead focus on individual associated factors, particularly male gender, older age at b\/tsDMARD initiation, chronic lung diseases and higher-dose corticosteroid exposure, while optimising the protective role of conventional DMARDs and regular follow-up for better disease control.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1759720x261423830","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T08:56:56Z","timestamp":1771837016000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Malignancy risk in patients with rheumatoid arthritis initiating biological or targeted synthetic disease-modifying antirheumatic drugs: a 5-year population-based cohort study"],"prefix":"10.1177","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2863-4350","authenticated-orcid":false,"given":"Chung-Mao","family":"Kao","sequence":"first","affiliation":[{"name":"Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan"},{"name":"Division of Translational Medicine, Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan"},{"name":"Doctoral Program in Tissue Engineering and Regenerative Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan"},{"name":"Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Po-Cheng","family":"Shih","sequence":"additional","affiliation":[{"name":"Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Changhua Christian 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Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7304-4587","authenticated-orcid":false,"given":"Hsin-Hua","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Boulevard, Taichung 40705, Taiwan"},{"name":"Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan"},{"name":"Institute of Biomedical Science, Rong Hsing Research Center for Translational Medicine and Big Data Center, National Chung Hsing University, Taichung, Taiwan"},{"name":"Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan"},{"name":"School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"},{"name":"Department of Digital Medicine, Taichung Veterans General Hospital, Taichung, 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