为了研究类风湿性关节炎（RA）、银屑病性关节炎（PsA）和强直性脊柱炎（AS）患者的首次生物药物疾病修复治疗在15年时间内的变化，我们评估了患者和疾病特征以及从2004年至2019年期间开始接受生物治疗（肿瘤坏死因子抑制剂，TNFi）的患者的药物生存率。开始阶段被归类为早期组（2004-2008年开始）、中间组（2009-2013年开始）和近期组（2014-2018年开始）。Kaplan-Meier曲线和log-rank检验评估了三个观察组之间以及疾病间药物存活率的总体差异，随后使用Cox回归来估计危险比（HRs）。我们包括了1938名连续开始接受TNFi治疗的患者，其中63%为RA，19%为PsA，19%为AS；65%为女性。药物存活率随时间显著下降（总体p<0.001），主要是因为近4年期间的下降：早期组相对于近期组的药物继续率的危险比（HR）为2.04（1.74-2.43），p<0.001；中间组相对于近期组的危险比为1.92（1.58-2.35），p<0.001。不同疾病间的药物存活时间也存在显著差异（总体p<0.001），主要是由于RA的存活时间较短：RA相对于PsA的药物继续率HR为0.58（0.47-0.73），p<0.001；RA相对于AS的药物继续率HR为0.63（0.51-0.78），p<0.001。RA、PsA和AS患者目前开始接受生物治疗（TNFi）后药物失效的时间比那些在药物问世后不久开始治疗的患者更短。这很可能是由于替代性新颖b/tsDMARDS治疗的可行性以及早期切换的治疗目标协议的推动和需要所导致的。

To study changes in retention of first biologic DMARD therapy over a period of 15 years in an inception cohort of patients with Rheumatoid arthritis (RA), Psoriatic arthritis (PsA) and Ankylosing Spondylitis (AS).We assessed patient and disease characteristics and drug survival of patients starting a biologic (Tumor Necrosis Factor inhibitor, TNFi) therapy between 2004 and 2019 in routine care at Reade. Starts were classified as Early (start 2004-2008), Intermediate (2009-2013) and Recent (2014-2018). Kaplan-Meier plots and log-rank tests assessed the overall difference in drug survival between the three observation groups and between diagnoses, followed by Cox regression to estimate hazard ratios (HRs).We included 1938 consecutive patients starting TNFi therapy, 63% RA, 19% PsA and 19% AS; 65% were female. Drug survival decreased significantly over time (overall p<0.001), mostly caused by decreases in the most recent 4 year period: Hazard ratio (HR) for drug continuation for the Early vs the Recent group: 2.04 (1.74-2.43), p<0.001, Intermediate vs the Recent group 1.92 (1.58-2.35), p<0.001. Drug survival time was significantly different between diseases (overall p<0.001), mostly caused by shorter survival in RA: HR for drug continuation for RA vs PsA 0.58 (0.47-0.73), p<0.001; and RA vs AS 0.63 (0.51-0.78), p<0.001.Patients with RA, PsA and AS currently initiating biologic (TNFi) therapy discontinue the drug much sooner than those starting shortly after the drugs were introduced. This is most likely due to the availability of alternative novel b/tsDMARDS treatments and treat-to-target protocols enabling and necessitating earlier switching.