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Study Suggests Biologics Are Safe and Effective for Many Patients with Elderly-Onset Rheumatoid Arthritis

Atlanta, GA—Results of a recent study presented at the 2019 American College of Rheumatology Annual Meeting suggest that patients with young-onset and elderly-onset rheumatoid arthritis (RA) derive similar benefits from biologic disease-modifying antirheumatic drugs (bDMARDs). Regardless of age at disease onset, both groups of patients had similar clinical improvements with bDMARD therapy at 48 weeks, as well as similar maintenance and discontinuation rates as a result of adverse events.

“Patients with elderly-onset RA could present with higher disease activity and increased disability compared with those with young-onset RA. Despite this, previous studies showed elderly patients receive biologics less frequently than younger individuals, suggesting that patients with elderly-onset RA may be undertreated,” said the lead investigator Sadao Jinno, MD, Rheumatologist, Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Osaka, Japan, at an official press conference during the meeting.

“On the other hand, in our daily practice, we see many patients with elderly-onset RA treated with biologics effectively and safely. We wanted to investigate if there are differences in efficacy and safety of biologics between young-onset and elderly-onset RA,” he said.

Study Details

The retrospective study was based on registry data from 7183 patients with RA aged ≥18 years who were enrolled in a Japanese multicenter observational registry between September 2009 and December 2017. Elderly-onset RA was defined as onset of the disease at age ≥60 years. Patients initiating treatment with biologics were required to have a ≥3.2 score on the Disease Activity Score in 28 joints and erythrocyte sedimentation rate measurement.

The researchers analyzed the relationship between age of RA onset and clinical effectiveness of therapy at 48 weeks. Secondary outcomes included biologic retention at 48 weeks, achievement of Clinical Disease Activity Index (CDAI) remission, and low disease activity or remission (LDA/remission).

Of 989 patients who initiated biologic treatment, 364 (36.8%) had elderly-onset RA and 624 (67%) had young-onset RA. Fewer patients in the elderly-onset RA group were being treated with biologics (18.3% vs 28% in young-onset patients, P  < .001).

The investigators noted that there were some significant differences in baseline characteristics between the 2 groups. For example, the young-onset RA group had more females (536 vs 267), patients had longer disease duration (11.2 ± 10.9 years vs 4.3 ± 4.6 years), and a higher percentage of patients were rheumatoid factor (RF)-positive (82.1% vs 73.7%). In addition, patients in this group had fewer tender joints and swollen joints compared with patients with elderly-onset RA.

In an analysis adjusted for significant differences in baseline characteristics between the 2 groups, there was no difference in CDAI scores at 48 weeks. A trend was observed toward lower index remission rates in the elderly-onset group, but LDA/remission rates were similar between the 2 groups.

“Our findings showed there were no significant differences in CDAI scores at 48 weeks between elderly-onset RA and young-onset RA, suggesting that biologics can be used for patients with elderly-onset RA as effectively as for those with young-onset RA. We also found no difference in treatment-related adverse event discontinuation rates between the two groups,” Dr Jinno stated.

He noted, however, that clinicians must use discretion when selecting which patients with elderly-onset rheumatoid arthritis will be treated with biologics and should take into account the risk for adverse events, particularly infections. The investigators plan to evaluate differential responses to specific biologics in patients with elderly-onset RA.

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