Objective. Biologics have been linked to both anti-autoimmune and anti-inflammatory mechanisms. We examine the long-term effects of biologics on rheumatoid arthritis (RA) patients in a real-world analytic cohort study using a nationwide database. Design. We designed a cohort study using the National Health Insurance Research Database in Taiwan between 1997 and 2010. Methods. Based on biologics and other anti-rheumatic agent prescriptions, we divided all patients into either the biologics group or the non-biologics group. The outcomes were the incidence rate of each comorbidity and the hazard ratio of each comorbidity between those using biologics and those not. We followed patients from the index date to the date on which the database ended. Results. In total, 19,681 patients were eligible for analysis in this study. During an average follow-up of 15 years, the event rates of each comorbidity differed significantly between the users and non-users of biologics with regard to cardiovascular comorbidity, metabolic comorbidity, rheumatologic comorbidity, and the miscellaneous comorbidity (all p<0.05). The usage of biologic agents in RA patients reduced the HR of cardiovascular comorbidities by 18%, metabolic comorbidities by 17%, rheumatology comorbidities by 36%, and miscellaneous comorbidities by 15% compared to those patients who did not use biologics. Oncology comorbidities and infection comorbidities were not affected by treatment with biologics (p>0.05). Conclusions. Biologics may have benefits beyond arthritis control with regard to reducing real-world comorbidities.

Comparison between early biologics treatment and late biologics treatment of rheumatoid arthritis (RA) patients in decreasing prescription days of glucocorticoids and painkillers by using the Taiwan National Health Insurance Research database from January 1, 1997 to December 31, 2013. We defined early use of biologics as biologics prescribed within 2.24 years after the RA diagnosis, and the late use of biologics was defined as those prescribed after 2.24 years of the RA diagnosis. These definitions are based on previous studies defining early arthritis as arthritis within 2 years of diagnosis, while we needed another 3 months for application biologics here in Taiwan, which equals a total of 2.24 years. Among the 821 patients, 410 patients (50%) were classified in the Early group, and the other 411 patients (50%) were classified in the Late group. The use of any of these three types of medication, including steroids, disease modifying antirhuematic drugs, and nonsteroid anti-inflammatory drug (NSAID) was changed significantly after biologics treatment. Comparing between before and after biologics treatment, oral medication was significantly tapered (all p <0.0001). The results show that men are 1.81 times more likely than women to taper oral glucocorticoids and NSAIDs. Younger age (<45) patients are 1.91 times more likely to taper steroids and NSAIDs than those aged over 65 years old. Both gender and age were found to be independent factors that could decrease days of prescription of both steroids and NSAIDs in early use of biologics agents. This study indicates that younger patients only need short-term (2.53±1.92 years, p=0.03) and early treatment with biologics (within 2.24 years of diagnosis of RA), just in order to taper steroids and NSAIDs to less than 50% than before biologics treatment.