Elderly-onset, nonelderly rheumatoid arthritis respond similarly to biologics
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Patients with elderly-onset rheumatoid arthritis have similar disease activity and adverse-event risk responses to biologics as nonelderly patients, according to data published in The Journal of Rheumatology.
“Elderly-onset RA (EORA) patients include those who develop RA after age 60 years; these patients tend to have different disease characteristics than patients with younger-onset RA (YORA),” Sae Ochi, PhD, of the Jikei University School of Medicine, in Tokyo, and colleagues wrote. “Although biological/targeted synthetic (b/ts) DMARDs promising treatment options for elderly RA patients with comorbidities, EORA patients are also less frequently treated with b/tsDMARDs compared with younger patients, which might be due to concerns about the risk of adverse events.
“Previous studies showed that advanced age is a significant risk factor for infectious diseases and serious adverse events among RA patients treated with b/tsDMARDs, particularly TNF inhibitors (TNFis), although others have reported no differences,” they added. “This recognition of serious adverse events often makes physicians hesitant to treat elderly patients with b/tsDMARDs. Most of this research compares EORA with YORA patients. As general risks in adverse events increase with age, the safety of these treatments may also need to be assessed within the same age group.”
To examine the efficacy and safety of biologic and targeted synthetic DMARDs in patients aged 60 years and older with elderly- and nonelderly-onset RA, Ochi and colleagues retrospectively analyzed data from the FIRST registry. According to the researchers, FIRST is a multi-institutional registry of patients with RA who are treated with biological or targeted synthetic DMARDs, starting in 2003 when the first such agent was approved in Japan. A total of 3,535 patients had been enrolled in the registry as of June 2019.
For their study, Ochi and colleagues included patients aged 60 years or older at the start of treatment. Those whose age of onset was 60 years or older were categorized as elderly-onset RA, while those whose age of onset was younger than 60 years were labeled nonelderly-onset. In all, 1,040 patients were included in the elderly-onset group, with 710 in the nonelderly-onset group. The researchers compared changes in Clinical Disease Activity Index (CDAI) and Health Assessment Questionnaire–Disability Index, as well as safety between the two cohorts.
According to the researchers, there were no significant differences in characteristics at baseline between elderly- and nonelderly-onset groups. The proportion of patients with low and high disease activity was comparable between the groups at weeks 2, 22 and 54. There were also no significant differences in the reasons for treatment discontinuation between the two groups.
Ochi and colleagues additionally found that elderly onset RA did not impact changes in CDAI and Health Assessment Questionnaire–Disability Index, nor did it affect the reasons for treatment discontinuation between the groups. The proportion of patients in each group and CDAI response trajectories to biologic or targeted synthetic DMARDs were “very similar” between elderly- and nonelderly-onset patients, they wrote.
Lastly, after controlling for age, gender, glucocorticoid and methotrexate doses, and agent types, there were no differences in hazard ratios for infection and serious adverse events between the two groups.
“Comparison of EORA and non-EORA elderly patients revealed that CDAI response trajectories to b/tsDMARDs were similar between EORA and non-EORA elderly,” Ochi and colleagues wrote. “There were not significant differences in reasons of the discontinuation of b/tsDMARDs and elderly onset did not affect changes in CDAI and HAQ-DI as well as reasons of the discontinuation between the two groups.”
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Ochi S, et al. J Rheumatol. 2021;doi:10.3899/jrheum.201135.
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