{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T05:02:09Z","timestamp":1784869329694,"version":"3.55.0"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To characterize real-world treatment patterns, including persistence, switching, and discontinuation, of biologic and targeted synthetic disease-modifying antirheumatic drugs (b\/tsDMARDs) in patients with rheumatoid arthritis (RA) in Saudi Arabia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study was conducted at Dammam Medical Complex in Saudi Arabia. Adult RA patients na\u00efve to b\/tsDMARDs who initiated therapy between January 1, 2013, and January 31, 2023, were included. Treatment patterns were summarized using descriptive statistics. Drug survival was assessed with Kaplan\u2013Meier curves and Cox proportional hazards models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 175 eligible patients, first-line therapy was a tumor necrosis factor inhibitor (TNFI) in 109 (62.3%), a non-TNFI in 47 (26.9%), and tofacitinib in 19 (10.9%). Estimated drug survival probabilities at 5\u202fyears were 0.47 (95% CI: 0.37\u20130.59) for TNFIs, 0.51 (95% CI: 0.38\u20130.68) for non-TNFIs, and 0.68 (95% CI: 0.48\u20130.97) for tofacitinib. At 10\u202fyears, survival was 0.33 (95% CI: 0.23\u20130.48) for TNFIs and 0.27 (95% CI: 0.16\u20130.45) for non-TNFIs. Kaplan\u2013Meier analysis showed no significant difference across classes (log-rank\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.68). Adjusted hazard ratios for switching or discontinuation (reference: TNFIs) were 1.10 (95% CI: 0.69\u20131.74,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.68) for non-TNFIs and 0.68 (95% CI: 0.27\u20131.72,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.42) for tofacitinib. The primary reason for switching was lack\/loss of efficacy, while pregnancy and non-adherence were the most frequent causes of discontinuation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Tumor necrosis factor inhibitors were the most commonly initiated first-line b\/tsDMARD in this Saudi cohort. Persistence appeared comparable across classes, although the small sample size limits definitive conclusions. These findings provide initial real-world insights into the utilization of advanced RA therapies at a single tertiary center in Saudi Arabia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1855256","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T04:24:27Z","timestamp":1784867067000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Persistence, switching, and discontinuation patterns of b\/tsDMARDs in patients with rheumatoid arthritis: a single-center retrospective cohort study from Saudi Arabia"],"prefix":"10.3389","volume":"13","author":[{"given":"Saad A.","family":"Aldosari","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University","place":["Al-Kharj, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Areej","family":"Alkhaleel","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Affairs, Dammam Medical Complex","place":["Dammam, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mukhtar","family":"Alomar","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Affairs, Dammam Medical Complex","place":["Dammam, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laila","family":"Alghalawin","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Affairs, Dammam Medical Complex","place":["Dammam, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Alamer","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University","place":["Al-Kharj, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"ITC1","DOI":"10.7326\/AITC201901010","article-title":"Rheumatoid arthritis","volume":"170","author":"Sparks","year":"2019","journal-title":"Ann Intern Med"},{"key":"ref2","volume-title":"Global, regional, and national Burden of Rheumatoid Arthritis, 1990\u20132020, and Projections to 2050: a systematic Analysis of the Global Burden of Disease Study 2021 \u2013 The Lancet Rheumatology","year":"2024"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"396","DOI":"10.5144\/0256-4947.1998.396","article-title":"The prevalence of rheumatoid arthritis in the Qassim region of Saudi Arabia","volume":"18","author":"Al-Dalaan","year":"1998","journal-title":"Ann Saudi Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"19297","DOI":"10.1038\/s41598-022-22310-0","article-title":"The 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