Bechman K, Oke A, Yates M, et al. - This study was undertaken to assess drug survival with monotherapy compared with combination therapy with MTX in RA older adults. Researchers recruited individuals from the British Society for Rheumatology Biologics Register, a prospective observational cohort, who were biologic naïve and commencing their first TNF inhibitors (TNFi). They used cox-proportional hazards models to compare the risk of TNFi discontinuation from any-cause, inefficacy and adverse events, between individuals prescribed TNFi-monotherapy correlated with TNFi MTX combination. A total of 15,700 individuals were included in this study. TNFi monotherapy is correlated with improved treatment failure. The disadvantage of TNFi monotherapy on drug survival is no longer seen in older adults. Compared with younger individuals, individuals ≥ 75 have fewer discontinuations due to inefficacy than adverse events. This likely indicates a greater disposition to toxicity but perhaps also a decline in immunogenicity correlated with immunosenescence.