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EORA was defined as RA with onset at 60 or over. To adjust confounding by indication for treatment with TNFi or IL-6i, a propensity score based on multiple baseline characteristics variables was used to compare the drug retention and causes for discontinuation between TNFi and IL-6i. Adjusted cumulative incidence of drug discontinuation for each reason was compared between the two groups using the Fine-Gray model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among a total of 9,550 patients in the registry, 674 TNFi and 297 IL-6i initiators with EORA were identified. Age, the proportion of females, disease duration, and baseline disease activity at the time of TNFi or IL-6i initiation were similar between the two groups. After adjusting for differences in baseline characteristics between the two groups, overall drug discontinuation was significantly lower in the IL-6i as compared to the TNFi (HR\u2009=\u20090.71, 95%CI\u2009=\u20090.59\u20130.86,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). The adjusted cumulative incidence of discontinuation due to lack of effectiveness was lower with the IL-6i (HR\u2009=\u20090.46, 95%CI\u2009=\u20090.33\u20130.63,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) while those due to adverse events (HR\u2009=\u20090.82, 95%CI\u2009=\u20090.56\u20131.18,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.28) or achievement of clinical remission (HR\u2009=\u20091.09, 95%CI\u2009=\u20090.62\u20131.91,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.76) were similar between the two groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In EORA patients initiating a TNFi or IL-6i, significantly higher drug retention was observed with IL-6i. Discontinuation due to lack of effectiveness was significantly less frequent in IL-6i while discontinuations due to adverse event or achievement of clinical remission were similar between the two groups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13075-021-02496-w","type":"journal-article","created":{"date-parts":[[2021,4,15]],"date-time":"2021-04-15T06:18:21Z","timestamp":1618467501000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Comparison of the drug retention and reasons for discontinuation of tumor necrosis factor inhibitors and interleukin-6 inhibitors in Japanese patients with elderly-onset rheumatoid arthritis\u2014the ANSWER cohort study"],"prefix":"10.1186","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3021-183X","authenticated-orcid":false,"given":"Sadao","family":"Jinno","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akira","family":"Onishi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maureen","family":"Dubreuil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Motomu","family":"Hashimoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wataru","family":"Yamamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichi","family":"Murata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tohru","family":"Takeuchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuya","family":"Kotani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuichi","family":"Maeda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kosuke","family":"Ebina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonsu","family":"Son","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideki","family":"Amuro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryota","family":"Hara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaki","family":"Katayama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Saegusa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,4,15]]},"reference":[{"issue":"12","key":"2496_CR1","doi-asserted-by":"publisher","first-page":"1575","DOI":"10.1093\/rheumatology\/kep291","volume":"48","author":"MD Koller","year":"2009","unstructured":"Koller MD, Aletaha D, Funovits J, Pangan A, Baker D, Smolen JS. 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The study was approved by the ethics committee of Kobe University (approval number 1738) as well as the ethics committees of all participating institutions. In our institute, the institutional review board waived the requirement for patients\u2019 informed consent because this study utilized only existing data collected in clinical practice. The opportunity to refuse participation in the research was ensured for the research subjects.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Sadao Jinno has received speaking fees from AbbVie G.K., Asahi Kasei Pharma., Bristol-Myers Squibb., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., Janssen Pharmaceutical K.K., and Mitsubishi Tanabe Pharma, and Ono Pharmaceutical Co. Akira Onishi reports grants from Advantest, personal fees from Asahi Kasei Pharma, Chugai Pharmaceutical Co., Ltd., Eli Lilly Japan K. K, Ono Pharmaceutical Co., Mitsubishi Tanabe Pharma, Takeda Pharmaceutical Company Limited, and Daiichi Sankyo Co. Ltd. Maureen Dubreuil has served on Advisory board for UCB Inc. Motomu Hashimoto and Koichi Murata belong to the department that is financially supported by the five pharmaceutical companies (Tanabe-Mitsubishi, Chugai, Ayumi, UCB-Japan, and Asahi-Kasei), Nagahama city and Toyooka city. Motomu Hashimoto has received speaking fees from Mitsubishi Tanabe Pharma and Bristol-Myers Squibb and has received research grants from Eli Lilly Japan K. K and Eisai Co., Ltd.. Koichi Murata has received a speaking fee and\/or consulting fee from Eisai Co., Ltd. Tohru Takeuchi has received grants from Chugai Pharmaceutical Co. Ltd., personal fees from Astellas Pharma Inc., Chugai Pharmaceutical Co. Ltd., Mitsubishi Tanabe Pharma Corporation, AbbVie GK, Bristol Myers Squibb, Ayumi Pharmaceutical Co., Daiichi Sankyo Co. Ltd., Eisai Co. Ltd., Takeda Pharmaceutical Co. Ltd., and Asahi Kasei Pharma. Yuichi Maeda received a research grant and\/or speaker fee from Eli Lilly Japan K.K., Chugai Pharmaceutical Co. Ltd., Pfizer Inc., Bristol Myers Squibb, and Mitsubishi Tanabe Pharma Corporation. Kosuke Ebina is affiliated with the Department of Musculoskeletal Regenerative Medicine, Osaka University, Graduate School of Medicine, which is supported by Taisho. Kosuke Ebina has received research grants from AbbVie G.K., Asahi Kasei Pharma., Astellas Pharma Inc., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Ono Pharmaceutical, Teijin Pharma, and UCB Japan. Kosuke Ebina has received payments for lectures from Abbie G.K., Asahi Kasei Pharma Corporation, Astellas Pharma Inc., Ayumi Pharmaceutical Co., Bristol-Myers Squibb, Chugai Pharmaceutical Co. Ltd., Eisai Co., Ltd., Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma Corporation, Ono Pharmaceutical, Pfizer Inc., Sanofi, and UCB Japan. Yonsu Son has received speaking fees from Actelion, Bristol-Myers Squibb., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., and Mitsubishi Tanabe Pharma, and Sanofi K.K. Hideki Amuro has received speaking fees from Asahi Kasei Pharma Corporation, Mitsubishi Tanabe Pharma Corporation, Astellas Pharma Inc., and Novartis Pharma KK. Ryota Hara has received speaking fees from AbbVie G.K. Jun Saegusa has received speaking fees from AbbVie G.K., Asahi Kasei Pharma., Eli Lilly Japan K.K., and Janssen Pharmaceutical K.K. The other authors have declared no conflicts of interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"116"}}