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A huge difference in the use of biologic DMARDs across European countries was reported in the QUEST-RA multinational study [ 29].
Moreover, the study covered the period from 2005 to 2009, an interval when the use of biologic DMARDs for PsA was still relatively new.
Understanding this potential therapeutic risk has become more relevant with the increasing use of biologic DMARDs as a routine therapeutic approach to RA management [ 3].
Other investigators using retrospective data analyses have also found relatively robust treatment persistence with the use of biologic DMARDs in the treatment of PsA [ 17, 18, 20].
The ever use of biologic DMARDs increased from 18.5% in the period 0 2 years to 62.6% in the period 2 10 years.
Registries and databases have reported an increased risk of serious bacterial infections with the use of biologic DMARDs (category A) [ 66– 66].
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The distribution of biologic DMARDs used in our outpatient clinic in the various years is reflected not only by clinical indications and doctors' preferences but also by the Norwegian tender system.
The objective of the current study was to compare the efficacy of biologic DMARDs used as monotherapy or in combination with MTX in terms of pain, self-reported disease activity, functional ability, and overall health related Quality of Life (HRQoL) among DMARD-IR RA patients based on currently available evidence from RCTs.
In multivariable Cox regression, initiation of either treatment was associated with an increase in comorbidities, previous number of nonbiologic DMARDs, calendar year, and disease activity (as measured by the Patient Activity Scale), and with a decrease in previous number of biologic DMARDs and current use of methotrexate, leflunomide, or azathioprine (Table 2).
Current EULAR recommendations suggest considering withdrawal of biologic DMARDs in patients in stable remission.
Patterns of biologic DMARD use may have changed in more recent years.
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