Introduction:This study aimed to investigate the interaction between the ABCG2 rs4148155 and SLC22A12 rs75786299 variants and their association with incident gout and nephrolithiasis in the Taiwanese population to better understand the genetic loci regulating hyperuricemia and their contribution to nephrolithiasis development. Methods:This retrospective case-control study involved 35,280 adults from the Taiwan Precise Medicine Initiative database. We examined the prevalence of gout and ultrasound confirmed nephrolithiasis as the primary and secondary outcome. Logistic regression models were used to explore the associations between genetic variants, serum uric acid levels, incident gout, and nephrolithiasis. Results:The frequencies of the rs4148155 variant and the rs75786299 variant were 63.2% and 3.7%, respectively. Among participants, 7,056 were gout, and 4,110 had nephrolithiasis. Multivariable odds ratios (ORs) for gout were 1.67 and 1.96 among rs4148155 and rs75786299 carriers, respectively (p = 0.01 and p < 0.001). For nephrolithiasis, the multivariable ORs were 1.1 and 1.11 for rs4148155 and rs75786299 carriers, respectively (p = 0.004 and p = 0.32). Sex-stratified analysis revealed an additive risk of gout and nephrolithiasis among carriers of these genetic variants, regardless of gender. Independent risk factors for nephrolithiasis included higher age, male gender, and the presence of gout, hypertension, and hyperlipidemia. Conclusion:The study highlights a significant association between the rs4148155, rs75786299 variants and the development of gout and nephrolithiasis, indicating an additive risk among carriers. These findings support precision healthcare approaches for individuals with risk genetic variants to target hyperuricemia, gout, and systemic comorbidities, ultimately preventing nephrolithiasis.

Real-world evidence on the treat-to-target strategy in atopic dermatitis (AD) remains limited. To evaluate targeted combined endpoints in AD, we conducted a cross-sectional study that included 100 adults with AD receiving treatment ≥ 6 months. Targeted endpoints included Patient Global Assessment (PGA) ≤ 2, Eczema Area and Severity Index (EASI) ≤ 7, visual analog scale (VAS) of pruritus ≤ 4, Patient Oriented Eczema Measure (POEM) ≤ 7, and Dermatology Life Quality Index (DLQI) ≤ 5. Logistic regression and receiver operating characteristic (ROC) curve analysis were performed to identify factors associated with achieving treatment targets. Latent class analysis (LCA) and principal component analysis (PCA) were performed to identify patient subgroups and data components. Only 30% met all five targeted endpoints. An increased age was associated with a higher probability of achieving all treatment targets (aOR: 1.04; 95% CI: 1.00-1.09). DLQI could favorably predict the achievement of all 5 treatment targets (AUROC: 0.93; 95% CI: 0.88, 0.97). Despite no significant differences across treatment groups, the proportion of patients achieving all targets was the highest in the dupilumab group, followed by the Janus kinase inhibitor (JAKi) group. LCA identified one subgroup of patients achieving favorable skin control but poor life quality. PCA showed that life quality-related factors other than the severity of skin lesions explained the majority of variance. In conclusion, achievement of targeted combined endpoints in AD remains suboptimal, partly due to life quality-related factors.

ObjectivesEvidence guiding treatment sequencing following Janus kinase inhibitor (JAKi) treatment failure in rheumatoid arthritis (RA) remains limited. This study aimed to compare treatment persistence and clinical effectiveness between JAKi cycling and biologic switching after discontinuation of an initial JAKi due to inadequate response.MethodsIn this multicenter retrospective cohort study, only patients who discontinued their first JAKi due to inadequate response were included. The primary outcome was 12-month drug retention. Inverse probability of treatment weighting (IPTW) was used to balance baseline characteristics. The secondary outcomes included reasons for discontinuation within 12 months and clinical effectiveness at 6 months, assessed using the European Alliance of Associations for Rheumatology (EULAR) response criteria.ResultsAmong the 186 patients, 44 (23.7%) cycled to another JAKi and 142 (76.3%) switched to biologic therapy. Cycling was associated with significantly higher 12-month drug retention than switching (IPTW-adjusted hazard ratio, 0.21; 95% CI, 0.08–0.59; P = 0.003). This difference was mainly driven by fewer discontinuations owing to insufficient efficacy. Concomitant glucocorticoid use independently predicted improved retention (adjusted hazard ratio, 0.44; 95% CI, 0.25–0.80; P = 0.007). At 6 months, EULAR good/moderate response rates were not significantly different between groups (78.6% vs. 62.0%), although adjusted analyses suggested a trend favoring cycling (odds ratio, 3.38; 95% CI, 1.02–11.24; P = 0.047).ConclusionsAmong patients with RA who had an inadequate response to their first JAKi, cycling to another JAKi was associated with superior 12-month drug retention with comparable short-term clinical effectiveness.

Introduction: This study aimed to investigate the interaction between the ABCG2 rs4148155 and SLC22A12 rs75786299 variants and their association with incident gout and nephrolithiasis in the Taiwanese population to better understand the genetic loci regulating hyperuricemia and their contribution to nephrolithiasis development. Methods: This retrospective case-control study involved 35,280 adults from the Taiwan Precise Medicine Initiative database. We examined the prevalence of gout and ultrasound confirmed nephrolithiasis as the primary and secondary outcome. Logistic regression models were used to explore the associations between genetic variants, serum uric acid levels, incident gout, and nephrolithiasis. Results: The frequencies of the rs4148155 variant and the rs75786299 variant were 63.2% and 3.7%, respectively. Among participants, 7,056 were gout, and 4,110 had nephrolithiasis. Multivariable odds ratios (ORs) for gout were 1.67 and 1.96 among rs4148155 and rs75786299 carriers, respectively (p = 0.01 and p < 0.001). For nephrolithiasis, the multivariable ORs were 1.1 and 1.11 for rs4148155 and rs75786299 carriers, respectively (p = 0.004 and p = 0.32). Sex-stratified analysis revealed an additive risk of gout and nephrolithiasis among carriers of these genetic variants, regardless of gender. Independent risk factors for nephrolithiasis included higher age, male gender, and the presence of gout, hypertension, and hyperlipidemia. Conclusion: The study highlights a significant association between the rs4148155, rs75786299 variants and the development of gout and nephrolithiasis, indicating an additive risk among carriers. These findings support precision healthcare approaches for individuals with risk genetic variants to target hyperuricemia, gout, and systemic comorbidities, ultimately preventing nephrolithiasis.

AIM:This study aimed to identify indicators for the early diagnosis and management of pulmonary arterial hypertension (PAH) in patients with connective tissue disease (CTD). METHOD:This retrospective study included patients with CTD who met the criteria for right heart catheterization (RHC) according to contemporary guidelines for pulmonary hypertension (PH) with an intermediate to high echocardiographic probability of PH at a medical center in Taiwan. The data collected was analyzed. RESULTS:This study enrolled 92 patients, comprising 21 with systemic sclerosis (SSc) and 71 without SSc (non-SSc). PH and PAH were diagnosed in 67 (72.8%) and 55 (59.8%) patients, respectively, and 41 (44.6%) patients required PAH-specific medications. A high echocardiographic probability of PH significantly predicted both PH and PAH in all patients (adjusted odds ratio [OR] 7.30, 95% confidence interval [CI] 2.34-22.76 and OR 6.02, 95% CI 1.65-21.93), as well as in the non-SSc subgroup (adjusted OR 20.51 [4.41-95.45] and 15.95 [2.62-96.92]). N-terminal pro-B-type natriuretic peptide (NT-proBNP) ≥ 300 pg/mL predicted PH in the overall cohort and non-SSc subgroup (adjusted OR 3.55 [1.15-10.96] and 5.22 [1.15-23.66]). Pericardial effusion was associated with PH and PAH in the overall cohort (adjusted OR 11.99 [1.35-106.62] and 11.13 [1.23-101.07]) but not in the non-SSc subgroup. None of the aforementioned parameters significantly associated with the need for PAH-specific medications. CONCLUSIONS:A high echocardiographic probability of PH and NT-proBNP ≥ 300 pg/mL predict PH in CTD patients. Pericardial effusion may further aid in PH/PAH detection, though not in the non-SSc subgroup. RHC remains essential to confirm treatment eligibility.

OBJECTIVE:To identify associated and protective factors of rapid spinal radiographic progression in axial spondyloarthritis (axSpA) using artificial intelligence (AI). METHODS:We conducted a hospital-based retrospective cohort study involving 242 axSpA patients taken ≥2 lateral spine radiographs between 2002 and 2024. Spinal damage was assessed with modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) by a deep learning model. Each pair of consecutive radiographs defined an observational interval (total 379 intervals); annual mSASSS progression rate was calculated for each interval. Demographics, clinical features, baseline mSASSS, activity indices, cumulative dosage of prescriptions, and laboratory recordings were collected. Time-dependent generalized estimating equations (GEE) were applied to identify associated or protective factors of rapid spinal radiographic progression (ΔmSASSS/year >1), accounting for within-patient correlation. RESULTS:For recorded intervals, mean mSASSS progression was 0.5/year; 26.7% of intervals showed progression >1/year. For enrolled patients, mean mSASSS progression was 0.6/year; 27.3% of intervals showed progression >1/year. Conditional multivariable GEE analysis revealed age at baseline mSASSS, especially ≥40 years, was independently associated with rapid mSASSS progression [adjusted odds ratio (aOR), 1.03; 95% confidence interval (CI), 1.003-1.06]. Higher cumulative dosage of non-steroidal anti-inflammatory drugs (NSAIDs) during the intervals was negatively associated with rapid mSASSS progression (aOR, 0.38; 95% CI, 0.19-0.75). Cumulative dosage of tumor necrosis factor inhibitors and secukinumab during the intervals was independent of rapid mSASSS progression. CONCLUSIONS:Using AI-assisted mSASSS scoring, this retrospective cohort study identified older age at assessment as an associated factor and full-dose NSAIDs use as protective factor for rapid spinal radiographic progression.

Prescriptive BW charts can facilitate discrimination between normal and abnormal birthweight. This study aimed to develop a prescriptive BW chart specific to Asian populations and assess its utility in predicting infant mortality. A retrospective cohort study was conducted using data from Taiwan National Health Insurance Research Database and National Birth Reporting Database. This study included 2 956 475 live-born singleton infants born to healthy mothers with uncomplicated pregnancies in Taiwan from January 1, 2004, to December 31, 2019. BW percentiles were estimated from GA 24-42 weeks by ranking the data in ascending order and calculating the percentile values based on the relative position of each observation within the dataset. Infant mortality rates were calculated for different GA groups, and optimal BW percentile cutoffs for predicting mortality were determined. A total of 2,255,989 infants (77.6%) from low-risk pregnancies were included in the development of the BW chart. Sex-specific BW percentiles were calculated. Optimal cutoff for predicting mortality were identified as follows: below the 22nd percentile or above the 96th percentile for extremely preterm infants (GA: 24-27 + 6 weeks), below the 11th percentile or above the 98th percentile for very preterm infants (GA: 28-31 + 6 weeks), below the 9th percentile or above the 99th percentile for moderately preterm infants (GA: 32-33 + 6 weeks), below the 8th percentile or above the 98th percentile for late preterm infants (GA: 34-36 + 6 weeks), and below the 7th percentile or above the 100th percentile for term infants (GA: > 37 weeks). A prescriptive BW chart was developed using data from a large population of Asian infants from low-risk pregnancies. BW percentiles were determined to predict infant mortality. Clinicians can utilize this approach to provide effective consultations to parents and improve decision-making processes.

Primary Sjogren’s syndrome (pSS) is often concomitant with fibromyalgia (FM). Salivary gland sonography aids in the diagnosis of pSS. We aimed to discover, in primary FM patients, the presence of pSS in undiagnosed patients through salivary gland sonography. We prospectively recruited 42 primary FM patients. FM symptoms were evaluated based on the revised Fibromyalgia Impact Questionnaire (FIQR). Salivary gland sonography was performed. Patients with positive findings underwent salivary gland biopsy. Comparisons were undertaken using the Mann–Whitney U tests and Chi-squared test. In primary FM patients, the prevalence of dry eye was 83%, and dry mouth was 90%. The salivary gland sonographic score did not differ between patients with and without dry eye/mouth. One patient with a positive finding at salivary gland sonography had a positive result of salivary gland biopsy. In the other four patients who received salivary gland biopsy, despite negative findings in salivary gland sonography, only one had a positive result of salivary gland biopsy. To be noted, scores evaluated by salivary gland sonography were negatively associated with levels of pain (rho = −0.360, p= 0.023) and levels of sleep quality (rho = −0.447, p = 0.004). Our pilot study demonstrated the potential of salivary gland biopsy in detecting undiagnosed pSS in primary FM patients.

To investigate the impact of an electronic medical record management system (EMRMS) on disease activity and the frequency of outpatient visits among patients with ankylosing spondylitis (AS). We identified 652 patients with AS who were followed up for at least 1 year before and after the first Ankylosing Spondylitis Disease Activity Score (ASDAS) assessment and compared the number of outpatient visits and average visit time within 1 year before and after the initial ASDAS assessment. Finally, we analyzed 201 patients with AS who had complete data and received ≥ 3 continuous ASDAS assessments at an interval of 3 months, and we compared the results of the second and third ASDAS assessments with those of the first. The number of annual outpatient visits increased after ASDAS assessment (4.0 (4.0, 7.0) vs. 4.0 (4.0, 8.0), p < 0.001), particularly among those with a high initial disease activity. The average visit time was reduced within 1 year after ASDAS assessment (6.4 (8.5, 11.2) vs. 6.3 (8.3, 10.8) min, p = 0.073), especially among patients whose with an inactive disease activity was < 1.3 (ASDAS C-reactive protein (CRP) 6.7 (8.8, 11.1) vs. 6.1 (8.0, 10.3) min, p = 0.033; ASDAS erythrocyte sedimentation rate (ESR) 6.4 (8.7, 11.1) vs. 6.1 (8.1, 10.0) min, p = 0.027). Among patients who received at least three ASDAS assessments, the third ASDAS-CRP tended to be lower than the first (1.5 (0.9, 2.1) vs. 1.4 (0.8, 1.9), p = 0.058). The use of an EMRMS increased the frequency of ambulatory visits among AS patients with high and very high disease activity and reduced the visit time among those with an inactive disease. Continual ASDAS assessments may help control the disease activity of patients with AS.

Elderly-onset rheumatoid arthritis (EORA) is associated with an increased mortality risk; however, the effect of conventional synthetic, biologics or targeted synthetic disease-modifying anti-rheumatic drugs (csDMARDs, bDMARDs or tsDMARDs) on the EORA-specific mortality risk is unknown. In this study, we investigated the risk factors for all-cause mortality of patients with EORA. Data of EORA patients diagnosed with RA at age > 60 years between January 2007 and June 2021 were extracted from the electronic health record of Taichung Veterans General Hospital, Taiwan. Multivariable Cox regression was used to calculate the hazard ratio (HR) and 95

BackgroundHyperuricemia and gout are risk factors of nephrolithiasis. However, it is unclear whether the ABCG2 gene contributes to the development of nephrolithiasis. We aimed to investigate the interaction between the ABCG2 rs2231142 variant and incident nephrolithiasis in the Taiwanese population.MethodsA total of 120,267 adults aged 30–70 years were enrolled from the Taiwan Biobank data-base in this retrospective case–control study and genotyped for rs2231142. The primary outcome was the prevalence of self-reported nephrolithiasis. The odds ratio (OR) of incident nephrolithiasis was analyzed by multivariable logistic regression models with adjustment for multifactorial confounding factors. Associations of the ABCG2 rs2231142 variant with serum uric acid levels, and the incident nephrolithiasis were explored.ResultsThe frequency of rs2231142 T allele was 53%, and 8,410 participants had nephrolithiasis. The multivariable-adjusted OR (95% confidence interval) of nephrolithiasis was 1.18 (1.09–1.28) and 1.12 (1.06–1.18) for TT and GT genotypes, respectively, compared with the GG genotype (p<0.001), specifically in the male population with hyperuricemia. Higher age, male sex, hyperlipidemia, hypertension, diabetes mellitus, hyperuricemia, smoking and overweight were independent risk factors for nephrolithiasis. In contrast, regular physical exercise is a protective factor against nephrolithiasis.ConclusionsABCG2 genetic variation is a significant risk of nephrolithiasis, independent of serum uric acid levels. For rs2231142 T allele carriers, our result provides evidence for precision healthcare to tackle hyperuricemia, comorbidities, smoking, and overweight, and recommend regular physical exercise for the prevention of nephrolithiasis.

Background and AimA large genetic effect of a novel gallstone-associated genetic variant, the hepatocyte nuclear factor 4 alpha (HNF4A) rs1800961 polymorphism, has been identified through recent genome-wide association studies. However, this effect has not been validated in Asian populations. We investigated the association between the rs1800961 variant and gallstones among a Taiwanese population.MethodsA total of 20 405 participants aged between 30 and 70 years voluntarily enrolled in the Taiwan Biobank. Self-report questionnaires, physical examinations, biochemical tests, and genotyping were used for analysis. The association of the HNF4A rs1800961 variant and other metabolic risks with gallstone disease was analyzed using multiple logistic regression models.ResultsThe minor T allele of HNF4A rs1800961 was associated with an increased risk of gallstone, and the association remained significant even after adjustment for other risk factors including age, body mass index (BMI), diabetes, hyperlipidemia, hypertension, and cigarette smoking (adjusted odds ratio [OR] = 1.90, 95% confidence interval [CI] = 1.31 to 2.75) in male participants. When further stratified by BMI and age, the lithogenic effect was the most significant in male participants with obesity (adjusted OR = 3.55, 95% CI = 1.92 to 6.56) and who were younger (adjusted OR = 2.45, 95% CI = 1.49 to 4.04).ConclusionThe novel gallstone-associated HNF4A rs1800961 variant was associated with the risk of gallstone in the Taiwanese men. Screening for the rs1800961 polymorphism may be particularly useful in assessing the risk of gallstone formation in younger or obese men.

Objectives To investigate the differences between the vector vaccine ChAdOx1 nCoV-19/AZD1222 (Oxford-AstraZeneca) and mRNA-based vaccine mRNA-1273 (Moderna) in patients with autoimmune rheumatic diseases (AIRD), and to explore the cell-cell interactions between high and low anti-SARS-CoV-2 IgG levels in patients with rheumatic arthritis (RA) using single-cell RNA sequencing (scRNA-seq). Methods From September 16 to December 10, 2021, we consecutively enrolled 445 participants (389 patients with AIRD and 56 healthy controls), of whom 236 were immunized with AZD1222 and 209 with mRNA-1273. The serum IgG antibodies to the SARS-CoV-2 receptor-binding domain was quantified by electrochemiluminescence immunoassay at 4-6 weeks after vaccination. Moreover, peripheral blood mononuclear cells (PBMCs) were isolated from RA patients at 4-6 weeks after vaccination for scRNA-seq and further analyzed by CellChat. ScRNA-seq of PBMCs samples from GSE201534 in the Gene Expression Omnibus (GEO) database were also extracted for analysis. Results The anti-SARS-CoV-2 IgG seropositivity rate was 85.34% for AIRD patients and 98.20% for healthy controls. The anti-SARS-CoV-2 IgG level was higher in patients receiving mRNA-1273 than those receiving AZD1222 (β: 35.25, 95% CI: 14.81-55.68, p=0.001). Prednisolone-equivalent dose >5 mg/day and methotrexate use in AIRD patients, and non-anti-tumor necrosis factor-α biologics and Janus kinase inhibitor use in RA patients were associated with inferior immunogenicity. ScRNA-seq revealed CD16-monocytes were predominant in RA patients with high anti-SARS-CoV2-IgG antibodies, and enriched pathways related to antigen presentation via MHC class II were found. HLA-DRA and CD4 interaction was enhanced in high anti-SARS-CoV2-IgG group. Conclusions mRNA-1273 and AZD1222 vaccines exhibited differential immunogenicity in AIRD patients. Enriched pathways related to antigen presentation via MHC class II in CD16-monocytes might be associated with higher anti-SARS-CoV2-IgG level in RA patients and further study is warranted.

Abstract Background To investigate the impact of an electronic medical record management system (EMRMS) on disease activity and the frequency of outpatient visits among patients with ankylosing spondylitis (AS). Methods We identified 652 patients with AS who were followed up for at least 1 year before and after the first Ankylosing Spondylitis Disease Activity Score (ASDAS) assessment and compared the number of outpatient visits and average visit time within 1 year before and after the initial ASDAS assessment. Finally, we analyzed 201 patients with AS who had complete data and received ≥ 3 continuous ASDAS assessments at an interval of 3 months, and we compared the results of the second and third ASDAS assessments with those of the first. Results The number of annual outpatient visits increased after ASDAS assessment (5.8 ± 3.4 vs. 5.4 ± 3.4, p < 0.001), particularly among those with a high initial disease activity. The average visit time was reduced within 1 year after ASDAS assessment (8.7 ± 3.8 vs. 9.2 ± 4.4 min, p = 0.030), especially among patients whose ASDAS-C-reactive protein (CRP) was < 1.3 (8.5 ± 3.3 vs. 9.2 ± 4.2 min, p = 0.022). Among patients who received at least three ASDAS assessments, the third ASDAS-CRP was significantly lower than the first (1.5 ± 0.8 vs. 1.6 ± 0.8, p = 0.049). Conclusion The use of an EMRMS increased the frequency of ambulatory visits among AS patients with high disease activity and reduced the visit time among those with an inactive disease. Continual ASDAS assessments may help control the disease activity of patients with AS. Trial registration Institutional Review Board (IRB) of Taichung Veterans General Hospital (TCVGH-IRB No.: CE20145B)

Objectives:The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) has been widely utilized to evaluate disease activity in patients with ankylosing spondylitis (AS) by an arbitrary cut-off of ≥4 to indicate high disease activity and initiate biological therapy. The Ankylosing Spondylitis Disease Activity Score (ASDAS) is a new composite index to assess AS disease activity states that have been defined and validated. ASDAS ≥2.1 was selected as a criterion to start biological therapy. The purpose of this study was to estimate the corresponding BASDAI and ASDAS cut-off in a Taiwanese AS cohort.Methods:From November 2016 to October 2018, we assessed the ASDAS and the BASDAI regularly and recorded demographic data for 489 AS patients in Taichung Veterans General hospital (TCVGH) using an electronic patient-reported data system linked to electronic medical records. We used receiver operating characteristic curves with Youden's J statistic to determine the BASDAI values that correspond to ASDAS disease activity cut-offs (i.e., 1.3, 2.1, and 3.5).Results:In our population, the best trade-off BASDAI values corresponding to ASDAS -C-reactive protein (CRP) 1.3, 2.1, and 3.5 were 2.1, 3.1, and 3.7, respectively. The optimal BASDAI values corresponding to ASDAS-erythrocyte sedimentation rates 1.3, 2.1, and 3.5 were 2.0, 2.6, and 4.8, respectively.Conclusion:We propose a revised BASDAI cut-off based on our data, as BASDAI scores are commonly used globally. A more reasonable, lower BASDAI cut-off to initiate or change biological therapy will bring us closer to better decisions to treat AS patients.

Background Mycophenolate mofetil (MMF) is extensively used for induction and maintenance therapy in patients with lupus nephritis (LN). Enteric-coated mycophenolate sodium (EC-MPS) was developed to reduce the adverse gastrointestinal effects of MMF. However, the therapeutic efficacy of MMF and EC-MPS in LN remains unclear. This study aimed to examine the treatment effects of EC-MPS in LN patients with prior MMF exposure. Methods In this medical records review study, we included 54 LN patients, of whom 34 converted from MMF to EC-MPS at equimolar doses in 2016-2018 (nonmedical switching group) and 20 received continuous MMF treatment. Patients achieving complete remission or partial remission before the conversion were categorized as responders, whereas those who had never achieved complete remission or partial remission were categorized as nonresponders. Results Baseline proteinuria was higher in the nonmedical switching group. Although elevation in proteinuria was observed after nonmedical switching, the serum creatinine concentration and estimated glomerular filtration rate both improved. Responders in the nonmedical switching group had lower proteinuria and higher complement 3 levels. In the subgroup analysis, albeit the modest increase in daily urine protein, anti-double-stranded DNA antibody levels, estimated glomerular filtration rate, and complements 3 and 4 seemed comparable after conversion. Conclusion Switching to EC-MPS demonstrated a similar short-term renal response to continuous MMF treatment in LN patients. Prospective randomized trials are required to verify our findings.

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-α) inhibitors, non-TNF-α 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-α inhibitors: 584; non-TNF-α inhibitors: 535; tofacitinib: 151). The independent protective factors for 3-year drug survival were positive rheumatoid factor (RF) (HR: 0.48, 95% CI: 0.27-0.85, p = 0.013) and biologics-naïve RA (HR: 0.61, 95% CI: 0.39-0.94, p = 0.024). In contrast, positive anti-citrullinated protein antibody (ACPA) (HR: 2.24, 95% CI: 1.32-3.79, p = 0.003) and pre-existing latent tuberculosis (HR: 2.90, 95% CI: 2.06-4.09, p<0.001) were associated with drug discontinuation. RA patients treated with TNF-α inhibitors exhibited better drug retention, especially in the biologics-naïve subgroup (p = 0.037). TNF-α inhibitors were associated with lower cumulative incidence of discontinuation due to inefficacy and adverse events (both p<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-α inhibitors and tofacitinib. In conclusion, bio-naïve status predicted better drug survival in TNF-α inhibitors-treated RA patients. RF and ACPA positivity predicted better abatacept drug survival. In contrast, ACPA negativity was associated with superior TNF-α inhibitors and tofacitinib survival.