OBJECTIVES: The 2015 American College of Rheumatology guidelines recommend advanced therapy (biologic disease-modifying antirheumatic drugs [DMARDs] or Janus kinase inhibitors) for patients with rheumatoid arthritis (RA) who have inadequate response (IR) to conventional DMARDs. Given limited existing evidence, we investigated real-world cDMARD-IR rates and factors associated with progression to advanced therapy. METHODS: Administrative claims from the HealthCore Integrated Research Database were used to select adult patients with ≥1 claim for cDMARDs between 01/01/2007 and 11/30/2014 (first drug claim = index date), ≥12 months of enrollment before (baseline) and after index, ≥1 claim for RA diagnosis and no fills for any DMARD over baseline, and no claims at any time for other conditions where advanced therapy is indicated. A previously-published algorithm was applied to identify cDMARD-IR status. First fill for advanced therapy over 12 months post-index was set as progression date. Patient demographic/clinical characteristics and utilization metrics were assessed over baseline and up to the progression date. Factors associated with progression were determined by logistic regression. RESULTS: Out of 11,274 cDMARD initiators, 9,426 (84%) were cDMARD-IR, of whom 2,046 (22%) progressed to advanced therapy. Most patients progressed to etanercept (49%), followed by adalimumab (23%) and infliximab (17%). Median (range) time-to-progression was 126 days (62-219). The top 5 factors associated with progression were index claim for methotrexate (OR 3.05, 95% CI 2.63-3.53), post-index cDMARD adherence (3.02; 2.39-3.81), any outpatient IV medication use (2.84; 2.49-3.24), laboratory tests (1.76; 1.43-2.15), and glucocorticoid use (1.57; 1.38-1.79). Age (0.97; 0.96-0.98) and baseline Quan-Charlson comorbidity score (0.91; 0.86-0.97) were negatively associated with progression. CONCLUSIONS: A majority of patients (84%) in this real-world population were cDMARD-IR, but only 22% of them progressed to advanced therapy over 12 months, indicating barriers to such treatments. Factors associated with progression may help in identifying patients at higher need for intensive treatment.