Background: Biological therapy prevents structural damage, improves functional capacity, and has provided an important advance in the treatment of rheumatoid arthritis (RA). In a real-life scenario, drug survival is an indirect measure of the efficacy, safety, and tolerability of a drug. The objective of the study was to analyze the drug survival rate of biological therapy in a national health system (SUS). Methods: A retrospective cohort study of the medication process of RA was carried out in public pharmacies of a Brazilian state from January 2010 to April 2017. The Kaplan-Meier survival analysis was applied. The survival rate was defined as the incidence of drug discontinuation. The retention rate was defined as the mean of months using the drug. Results: Of the total of 902 individuals, 83.6% were female with a mean age of 56 years. Anti-TNF, mostly adalimumab (ADA), was the main biological agent prescribed. Mean drug retention of the first biological was 59.6 months (95% CI: 56.7 - 62.5), followed by 53.7 (95% CI: 48 - 59.4) and 28.2 (95% CI: 23.1 - 23.3) months for the second and third biologicals, respectively. Among the anti-TNF group, ADA, ETN, IFX had the better retention rate. There was no statistical difference in the general survival analyses (p = 0.18) among the groups. However, along the first 2 years, ADA, ETN, and RTX had the three better drug survival. The drug retention seems to increase with age (p = 0.036), with the subgroups > 70 years of age having the highest means (70 - 80 years: 67.29; >80: 67.53). Among all, 27.1% of patients switched to a second biologic. Conclusion: The anti-TNF group, mostly adalimumab (ADA), is the most prescribed medication as first and second-line therapy, reflecting its accessibility in the SUS and efficiency of the follow-up protocols. Among the anti-TNF group, ADA, ETN, and IFX had the better retention rate. Additionally, ADA and ETN had the better drug survival for the first treatment in the first 2 years. RTX was the non-anti-TNF with the best survival. A quarter of patients who start a biological therapy fail and switch to another drug (27%).
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