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Article History

Received: 19 November 2025

Accepted: 8 May 2026

First Online: 24 July 2026

Declarations

Conflict of interest: Taylor T Schwartz, Kristofer Norris: employee of Avalere, a company which received funding from Bristol Myers Squibb to perform the study and provides advisory services to the life sciences industry. Hanke Zheng: Fellowship with Bristol Myers Squibb. Laetitia N’Dri, Sang Hee Park, Vardhaman A Patel, Keith Wittstock, Vadim Khaychuk: employees and stockholders of Bristol Myers Squibb. Scott B Robinson, Alison R Silverstein: employees of Inovalon, a company which received funding from Bristol Myers Squibb to perform the study and provides advisory services to the life sciences industry. Jeffrey A Sparks: research funding: Arthritis Foundation, Boehringer Ingelheim, Bristol Myers Squibb, Johnson & Johnson, Llura Gund Award of the Gordon and Llura Gund Foundation, National Heart, Lung, and Blood Institute (R01 HL155522), National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01 AR080659, R01 AR077607, P30 AR070253, and P30 AR072577), R. Bruce and Joan M. Mickey Research Scholar Fund, Rheumatology Research Foundation, and Sonoma Biotherapeutics; consulting fees: AbbVie, Amgen, Anaptys, AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Fresenius Kabi, Gilead, Inova Diagnostics, Invivyd, Johnson & Johnson/Janssen, Merck, MustangBio, Novartis, Optum, Pfizer, ReCor, Sana, Sobi, and UCB. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard University, its affiliated academic health care centers, or the National Institutes of Health. The following authors have updated affiliations since the time of the analysis: Laetitia N’Dri (Merck), Vardhaman A Patel (Genmab), Scott B Robinson (ZS), Vadim Khaychuk (Biogen), Alison R Silverstein (EntityRisk).

Ethical Approval: As this was a secondary data analysis of statistically de-identified data, obtaining ethics approval and patient consent was not necessary. Approval to access the Medicare data is governed by an established research-oriented data use agreement with Centers for Medicare & Medicaid Services. Approval to access the Prognos laboratory data was governed by a data use agreement with Prognos.