Pappas DA, St John G, Etzel CJ, et al. - This research was undertaken to investigate the comparative efficacy of a tumor necrosis factor inhibitor (TNFi) vs a non-TNFi (biological disease-modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs)) as the first-line treatment following conventional synthetic DMARDs, as well as potential modifiers of response, observed in US clinical practice. Researchers enrolled data from a large US healthcare registry (Consortium of Rheumatology Researchers of North America Rheumatoid Arthritis Registry). The study enrolled individuals (aged ≥18 years) with a documented diagnosis of rheumatoid arthritis (RA), a valid baseline Clinical Disease Activity Index score of > 2.8, and no prior bDMARD or tsDMARD use.  No significant differences were found in outcomes between first-line TNF vs first-line non-TNF groups support RA guidelines, which recommend individualized care based on clinical judgement and consideration of individual preferences.