Evidence map›Paper›PMID 41849340›Full record

ArticlePloS one2026

Mode of action-specific and cause-specific retention of biologic and targeted synthetic disease-modifying antirheumatic drugs in anti-SS-A antibody-positive rheumatoid arthritis: The ANSWER cohort study.

Kazuma Nishisaka, Takaichi Okano, Takumi Imai, Masanori Tsubosaka, Tomoyuki Kamenaga, Naoki Nakano, Shinya Hayashi, Wataru Yamamoto, Akira Onishi, Kosaku Murakami and 18 more

Abstract readMulticenter Study
In one paragraph

Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

28 authors.

Kazuma NishisakaDepartment of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Kobe, Japan.ORCID https://orcid.org/0000-0003-1604-5249
Takaichi OkanoDepartment of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Kobe, Japan.ORCID https://orcid.org/0000-0002-0873-5728
Takumi ImaiClinical and Translational Research Center, Kobe University Hospital, Kobe, Japan.
Masanori TsubosakaDepartment of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Tomoyuki KamenagaDepartment of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Naoki NakanoDepartment of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Shinya HayashiDepartment of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Wataru YamamotoDepartment of Health Information Management, Kurashiki Sweet Hospital, Okayama, Japan.
Akira OnishiDepartment of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan.ORCID https://orcid.org/0000-0002-3120-1273
Kosaku MurakamiCenter for Cancer Immunotherapy and Immunobiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Kohei TsujimotoDepartment of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, The University of Osaka, Osaka, Japan.
Masao KatsushimaDepartment of Clinical Immunology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
Ayaka YoshikawaDepartment of Internal Medicine (IV), Division of Rheumatology, Osaka Medical and Pharmaceutical University, Osaka, Japan.
Takuya KotaniDepartment of Internal Medicine (IV), Division of Rheumatology, Osaka Medical and Pharmaceutical University, Osaka, Japan.
Hideki AmuroFirst Department of Internal Medicine, Kansai Medical University, Osaka, Japan.
Yonsu SonFirst Department of Internal Medicine, Kansai Medical University, Osaka, Japan.
Tetsu ItamiDepartment of Hematology and Rheumatology, Kindai University School of Medicine, Osaka, Japan.
Yuji NozakiDepartment of Hematology and Rheumatology, Kindai University School of Medicine, Osaka, Japan.
Yoko NoseDepartment of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Kobe, Japan.
Mai YamashitaDepartment of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Kobe, Japan.
Iku ShirasugiDepartment of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Kobe, Japan.
Hirotaka YamadaDepartment of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Kobe, Japan.
Keisuke NishimuraDepartment of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Kobe, Japan.
Yo UedaDepartment of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Kobe, Japan.
Sho SendoDepartment of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Kobe, Japan.ORCID https://orcid.org/0000-0002-7193-341X
Motomu HashimotoDepartment of Clinical Immunology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
Ryosuke KurodaDepartment of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Jun SaegusaDepartment of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Kobe, Japan.ORCID https://orcid.org/0000-0001-7606-3743

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Anti-SS-A (Ro) antibody-positive rheumatoid arthritis (RA) constitutes a clinically important subgroup, but its impact on retention of biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) across different modes of action (MOA) and reasons for discontinuation remains unclear. We conducted a multicenter retrospective analysis of the Japanese ANSWER cohort, including RA patients who started or switched b/tsDMARDs between 2011 and 2024 and had baseline anti-SS-A antibody testing. Among 1,452 patients (2,703 treatment courses), 255 patients (17.6%) were anti-SS-A antibody positive (507 courses, 18.8%). Propensity score matching balanced baseline characteristics, and drug retention was evaluated using Kaplan-Meier and competing risk analyses. Overall discontinuation was analyzed using Cox proportional hazards models, and Fine-Gray subdistribution hazards models were used for discontinuation by reason and for adverse event-related discontinuation stratified by MOA. After matching, 507 treatment courses from 255 anti-SS-A antibody-positive patients and 1,014 courses from 628 antibody-negative patients were analyzed. Anti-SS-A antibody positivity was not associated with overall b/tsDMARD retention (hazard ratio [HR] 1.07, 95% confidence interval [CI] 0.91-1.26, p = 0.382). In MOA-stratified analyses, positivity showed a trend toward increased discontinuation with interleukin-6 (IL-6) receptor inhibitors and cytotoxic T lymphocyte-associated antigen 4-immunoglobulin (CTLA4-Ig). In competing-risk analyses, discontinuation due to adverse events was significantly more frequent in antibody-positive patients (subdistribution hazard ratio [sHR] 1.80, 95% CI 1.28-2.52; p = 0.000685). Among adverse event-related discontinuations, anti-SS-A antibody positivity was associated with higher risks with IL-6 receptor inhibitors (sHR 2.41, 95% CI 1.24-4.71; p = 0.0098) and tumor necrosis factor (TNF) inhibitors (sHR 2.04, 95% CI 1.22-3.40; p = 0.0066), but not with CTLA4-Ig or Janus kinase (JAK) inhibitors. These findings suggest that treatment tolerability, rather than overall efficacy, may be a key determinant of b/tsDMARD survival in anti-SS-A antibody-positive RA and that MOA- and cause-specific profiles should be considered when selecting therapies in this subgroup.

Indexed as

Antirheumatic AgentsArthritis, RheumatoidAgedFemaleHumansMaleMiddle AgedProportional Hazards ModelsRetrospective StudiesAntirheumatic Agents

Identifiers

PMID41849340
PMCPMC12998854

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