{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T19:17:45Z","timestamp":1791227865017,"version":"4.1.0"},"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2021,4,30]],"date-time":"2021-04-30T00:00:00Z","timestamp":1619740800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010101","name":"Taichung Veterans General Hospital","doi-asserted-by":"publisher","award":["TCVGH-1087312C"],"award-info":[{"award-number":["TCVGH-1087312C"]}],"id":[{"id":"10.13039\/501100010101","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>\n                    In this study we aimed to identify the predictors of drug survival for biologic and targeted synthetic DMARDs (bDMARDs and tsDMARDs) among patients with rheumatoid arthritis (RA) in a real-world setting. Data from RA patients receiving bDMARDs and tsDMARDs between 2007 and 2019 were extracted from the Taiwan Rheumatology Association Clinical Electronic Registry (TRACER). Patients were categorized into tumor necrosis factor-alpha (TNF-\u03b1) inhibitors, non-TNF-\u03b1 inhibitors, and tofacitinib groups. The primary outcome was 3-year drug retention and the causes of bDMARDs and tsDMARDs discontinuation were recorded. Baseline demographic data before the initiation of bDMARDs and tsDMARDs treatment were analyzed to identify the predictors of 3-year drug survival. A total of 1,270 RA patients were recruited (TNF-\u03b1 inhibitors: 584; non-TNF-\u03b1 inhibitors: 535; tofacitinib: 151). The independent protective factors for 3-year drug survival were positive rheumatoid factor (RF) (HR: 0.48, 95% CI: 0.27\u20130.85,\n                    <jats:italic>p<\/jats:italic>\n                    = 0.013) and biologics-na\u00efve RA (HR: 0.61, 95% CI: 0.39\u20130.94,\n                    <jats:italic>p<\/jats:italic>\n                    = 0.024). In contrast, positive anti-citrullinated protein antibody (ACPA) (HR: 2.24, 95% CI: 1.32\u20133.79,\n                    <jats:italic>p<\/jats:italic>\n                    = 0.003) and pre-existing latent tuberculosis (HR: 2.90, 95% CI: 2.06\u20134.09, p&lt;0.001) were associated with drug discontinuation. RA patients treated with TNF-\u03b1 inhibitors exhibited better drug retention, especially in the biologics-na\u00efve subgroup (\n                    <jats:italic>p<\/jats:italic>\n                    = 0.037). TNF-\u03b1 inhibitors were associated with lower cumulative incidence of discontinuation due to inefficacy and adverse events (both\n                    <jats:italic>p<\/jats:italic>\n                    &lt;0.001). Baseline RF and ACPA positivity in abatacept-treated patients were associated with a better 3-year drug survival. However, negative ACPA levels predicted superior drug survival of TNF-\u03b1 inhibitors and tofacitinib. In conclusion, bio-na\u00efve status predicted better drug survival in TNF-\u03b1 inhibitors-treated RA patients. RF and ACPA positivity predicted better abatacept drug survival. In contrast, ACPA negativity was associated with superior TNF-\u03b1 inhibitors and tofacitinib survival.\n                  <\/jats:p>","DOI":"10.1371\/journal.pone.0250877","type":"journal-article","created":{"date-parts":[[2021,4,30]],"date-time":"2021-04-30T13:39:43Z","timestamp":1619789983000},"page":"e0250877","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":28,"title":["Predictors of drug survival for biologic and targeted synthetic DMARDs in rheumatoid arthritis: Analysis from the TRA Clinical Electronic Registry"],"prefix":"10.1371","volume":"16","author":[{"given":"Ching-Tsai","family":"Lin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Nan","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Chan","family":"Tsai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun-Peng","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Ting","family":"Hung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsu-Yi","family":"Hsieh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsin-Hua","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia-Wei","family":"Hsieh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuo-Lung","family":"Lai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuo-Tung","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chih-Wei","family":"Tseng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Der-Yuan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Hsin","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7593-3065","authenticated-orcid":true,"given":"Yi-Ming","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,4,30]]},"reference":[{"key":"pone.0250877.ref001","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/j.semarthrit.2013.06.001","article-title":"Sex- and age-specific incidence of autoimmune rheumatic diseases in the Chinese population: a Taiwan population-based study","volume":"43","author":"LC See","year":"2013","journal-title":"Semin Arthritis Rheum"},{"key":"pone.0250877.ref002","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/art.39480","article-title":"2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis","volume":"68","author":"JA Singh","year":"2016","journal-title":"Arthritis Rheumatol"},{"key":"pone.0250877.ref003","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1136\/annrheumdis-2019-216655","article-title":"EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update","volume":"79","author":"JS Smolen","year":"2020","journal-title":"Ann Rheum Dis"},{"key":"pone.0250877.ref004","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.1001\/jama.2018.13103","article-title":"Diagnosis and Management of Rheumatoid Arthritis: A Review","volume":"320","author":"D Aletaha","year":"2018","journal-title":"Jama"},{"key":"pone.0250877.ref005","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1038\/nrrheum.2015.8","article-title":"Rheumatoid arthritis therapy reappraisal: strategies, opportunities and challenges","volume":"11","author":"JS Smolen","year":"2015","journal-title":"Nat Rev Rheumatol"},{"key":"pone.0250877.ref006","first-page":"523","article-title":"Rate of discontinuation and drug survival of biologic therapies in rheumatoid arthritis: a systematic review and meta-analysis of drug registries and health care databases","volume":"55","author":"A Souto","year":"2016","journal-title":"Rheumatology (Oxford)"},{"key":"pone.0250877.ref007","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1093\/rheumatology\/ket301","article-title":"Predictors of response and remission in a large cohort of rheumatoid arthritis patients treated with tocilizumab in clinical practice","volume":"53","author":"YM Pers","year":"2014","journal-title":"Rheumatology (Oxford)."},{"key":"pone.0250877.ref008","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1186\/s13075-019-1917-8","article-title":"Raynauld JP et al. 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