Biologics Show Similar Efficacy in Older Patients as in Younger, No Matter When RA Begins

The lead author said the results indicate that biologics can be used in older patients with rheumatoid arthritis (RA) as effectively as in those who are younger.
Allison Inserro
November 13, 2019
Patients whose rheumatoid arthritis (RA) set in both later in life and earlier in life had similar improvements in disease activity at 48 weeks of treatment with a biologic, according to a study presented at the American College of Rheumatology Annual Meeting in Atlanta, Georgia.

The study assessed the relationship between the age of RA onset and the clinical effectiveness of therapy at 48 weeks. The primary outcome was the Clinical Disease Activity Index (CDAI) score at 48 weeks; secondary outcomes included biologic retention, or drug maintenance rate, at 48 weeks; achievement of a CDAI remission and low disease activity; or remission.

Researchers conducted the study with 7183 patients with RA who were 18 years or older and enrolled in a Japanese multicenter observational registry between September 2009 and December 2017. The inclusion criteria required that patients had to have a 3.2 or higher on the Disease Activity Score in 28 joints (DAS28) and erythrocyte sedimentation rate measurement when they started biologics.
 
The proportion of patients on biologics was lower in the group for whom RA began at an older age, defined as 60 years and older (18.3% vs 28.0%; P <.001). Of the 989 patients who began biologics, 364 (37%) were defined as elderly.

After adjusting for differences in baseline characteristics between the 2 age groups, there was no significant difference in CDAI score at 48 weeks.

They did find a trend toward lower index remission rates in the over-60 group, but low disease activity/remission rates were similar between both groups (odds ratio, 0.86; 95% CI, 0.29-2.52; P = .77).

Drug maintenance rates (hazard ratio [HR], 0.95; 95% CI, 0.55-1.35; P =.78) and adverse event discontinuation rates (HR, 0.78; 95% CI, 0.38-1.18; P = .22) were similar between the 2 age groups after adjusting for other confounders.

“Patients with elderly-onset RA could present with higher disease activities and increased disabilities as compared to those with young-onset RA. Despite this, previous studies showed elderly patients receive biologics less frequently than younger individuals, suggesting patients with elderly-onset RA are potently undertreated,” said Sadao Jinno, MD, MSc, instructor of rheumatology at Kobe University School of Medicine and the study’s lead author, in a statement. “On the other hand, in our daily practice, we have seen many elderly-onset RA patients treated with biologics effectively and safely. We wanted to investigate if there are differences in efficacy and safety of biologics between the two age groups.”

He said the results suggest that biologics can be used in older-age patients as effectively as in those who are younger.

“Clinicians should choose wisely which patients with elderly-onset RA are safely treated with biologics given that they are still at risk of developing adverse events, especially infections,” he added. “Next, we plan to investigate if patients with elderly-onset RA respond differently to various modes of biologics.”

Reference
Jinno S, Onishi A, Akash K, et al. Are there differences in efficacy and safety of biological disease-modifying antirheumatic drugs between elderly-onset and young-onset rheumatoid arthritis? Presented at: The American College of Rheumatology Annual Meeting, November 8-13, 2019; Atlanta, GA. Abstract 1345.

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