ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2480

Disease-Modifying Antirheumatic Drug Use and Toxicities Among Elderly Patients with Rheumatoid Arthritis

Rebecca L. Manno1, Dimitrios A. Pappas2, Katherine C. Saunders3, George Reed4, Shannon Grant5 and Clifton O. Bingham III6, 1Division of Rheumatology, Johns Hopkins University, Baltimore, MD, 2New York Presbyterian Hospital, Columbia University, College of Physicians & Surge, New York, NY, 3Corrona, LLC., Southborough, MA, 4Division of Behavioral and Preventive Medicine, University of Massachusetts Medical School, Worcester, MA, 5Axio Research LLC, Seattle, WA, 6Department of Medicine, Johns Hopkins University, Baltimore, MD

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: ,

Session Information

Title: Rheumatoid Arthritis - Clinical Aspects IV: Non-biologic Drugs for Rheumatoid Arthritis: New Insights on Comorbidities and Adverse Events

Session Type: Abstract Submissions (ACR)

Background/Purpose: The aging population has resulted in large numbers of older individuals requiring treatment for rheumatoid arthritis (RA). We sought to describe the clinical characteristics of elderly (≥70 yrs) RA pts in a large prospective cohort and determine the frequency of DMARD use and factors associated with drug toxicities among elderly RA pts.   Methods: Data were obtained from the Consortium of Rheumatology Researchers of North America (CORRONA) registry; an independent prospective observational cohort with >30,000 RA patients from over 100 US academic and private practices.  We evaluated RA pts aged ≥ 70 yrs with ≥1 post-enrollment follow up (f/u) visit after age 70 [the ‘index visit (IV)]. Pts were classified as either aging with RA (RA onset <70) or older-age onset RA (RA onset ≥70). A subset of older RA patients with > 12 mo f/u beyond the IV was also identified. Demographic, clinical, and DMARD data were obtained. Unadjusted ORs were calculated to determine characteristics associated with DMARD or biologic exposure and drug-associated toxicities at IV and 12 mo f/u.   Results: 5801 RA pts age ≥70 yrs were identified with the following clinical features: 44% erosive, 30.8% joint deformities, mHAQ 0.7 ± 0.6. 4017 elderly RA patients were aging with RA (RA onset 56 ± 10.9 yrs) and 1784 had older-age onset RA (RA onset 75 ± 4.6 yrs). Mean age at IV was 74.9 ± 5.1 yrs with disease duration 13 ±11.6 yrs. 88.6% were on DMARD treatment (68.8% MTX, 34.8% biologic). Among those with 12 mo f/u (n=4077), 93.8% were on DMARD therapy (73.6% MTX, 42.8% biologic) with 16.1% adding a DMARD during f/u. Drug toxicity with non-biologic (1.6%) and biologic DMARDs (0.4%) was overall low. Among those with 12 mo f/u, 3.9% reported toxicity associated with non-biologic DMARD and 0.9% with biologic DMARD. The most commonly reported infection was URI (9%). Factors associated with DMARD, biologic use, or adverse events at the IV or 12 mo f/u are reported in Table 1.   Conclusion: Most elderly (≥70) RA pts in this large cohort received DMARD therapy, but DMARD and biologic toxicities were very low (<5%). Age of RA onset and age at f/u were not associated with increased biologic side effects. Greater RA severity and longer RA duration influenced if elderly RA patients were on DMARD or biologic therapy. Disability was strongly associated with risk of serious infection in this older age group. Limitations of this study include limited data on co-morbid conditions and precise medication timing. These data confirm that elderly RA patients tolerate DMARD and biologic therapy well with low rates of side effects and emphasize that treatment decisions for RA should never be based on age alone. However, disabled elderly RA patients are at high risk for serious infections. This vulnerable population should be the focus of future studies to determine strategies to improve outcomes beyond measures of RA activity alone.   Table 1.

Outcome Parameter OR (95% CI) at index visit OR (95% CI) at 12 mo follow up
DMARD use N (%) 5141 (88.6%) 3825 (93.8%)
  RA onset ≥70 yo 0.961 (0.807, 1.144) 1.140 (0.857, 1.517)
  Duration of RA 0.996 (0.989, 1.003) 0.990 (0.979, 1.000)
  Age 0.990 (0.975, 1.005) 0.994 (0.970, 1.020)
  Patient global assessment 0.997 (0.994, 1.001) 0.999 (0.993, 1.004)
  Physician global assessment 0.991 (0.987, 0.996) * 0.998 (0.991, 1.006)
  Swollen joint count 0.983 (0.968, 0.997) * 1.010 (0.984, 1.036)
  Tender joint count 0.977 (0.962, 0.993) * 1.018 (0.985, 1.051)
  Modified HAQ 0.862 (0.724, 1.027) 0.815 (0.611, 1.087)
  DAS28 0.870 (0.791, 0.957) * 0.995 (0.846, 1.170)
       
Biologic use N (%) 2021 (34.8%) 1744 (42.8%)
  RA onset ≥70 yo 0.551 (0.487, 0.623) * 0.576 (0.501, 0.662) *
  Duration of RA 1.022 (1.017, 1.026) * 1.019 (1.013, 1.025) *
  Age 0.970 (0.960, 0.981) * 0.966 (0.954, 0.978) *
  Patient global assessment 1.004 (1.002, 1.006) * 1.005 (1.003, 1.008) *
  Physician global assessment 1.004 (1.001, 1.007) * 1.011 (1.008, 1.015) *
  Swollen joint count 1.001 (0.991, 1.012) 1.028 (1.016, 1.041) *
  Tender joint count 1.014 (1.002, 1.026) * 1.041 (1.026, 1.056) *
  Modified HAQ 1.476 (1.311, 1.662) * 1.708 (1.468, 1.988) *
  DAS28 1.006 (1.004, 1.133) * 1.177 (1.095, 1.265) *
       
Infection requiring hospitalization N (%) 34 (0.6%) 41 (1%)
  RA onset ≥70 yo 0.481 (0.199, 1.163) 0.323 (0.126, 0.825) *
  Duration of RA 1.026 (1.001, 1.051) * 1.038 (1.016, 1.061) *
  Age 0.900 (0.824, 0.984) * 0.946 (0.881, 1.015)
  Patient global assessment 1.019 (1.007, 1.031) * 1.011 (0.999 1.023)
  Physician global assessment 1.027 (1.013, 1.042) * 1.007 (0.990, 1.024)
  Swollen joint count 1.062 (1.010, 1.115) * 1.001 (0.942, 1.063)
  Tender joint count 1.092 (1.046, 1.141) * 1.073 (1.025, 1.063) *
  Modified HAQ 2.763 (1.658, 4.604) * 2.933 (1.753, 4.905) *
  DAS28 1.458 (1.012, 2.100) * 1.010 (0.719, 1.417)
  h/o MTX 1.876 (0.572, 6.150) 2.321 (0.714, 7.544)
  h/o biologic 4.381 (1.980, 9.696) * 2.631 (1.375, 5.034)*
       
Toxicity associated with biologic use N (%) 23 (0.4%) 35 (0.9%)
  RA onset ≥70 yo 0.794 (0.312, 2.018) 0.937 (0.449, 1.958)
  Duration of RA 1.024 (0.464, 2.591) 1.013 (0.692, 2.694)
  Age 0.963 (0.882, 1.052) 0.966 (0.899, 1.039)
  Patient global assessment 1.011 (0.996, 1.027) 1.006 (0.992, 1.020)
  Physician global assessment 1.002 (0.980, 1.025) 1.016 (1.000, 1.033)
  Swollen joint count 0.995 (0.918, 1.080) 1.042 (0.989, 1.099)
  Tender joint count 0.968 (0.867, 1.080) 1.013 (0.944, 1.086)
  Modified HAQ 1.560 (0.721, 3.377) 1.419 (0.705, 2.854)
  DAS28 0.551 (0.257, 1.180) 1.107 (0.742, 1.651)
  h/o MTX 0.650 (0.241, 1.756) 0.726 (0.316, 1.670)

* p <0.05

Disclosure:

R. L. Manno,
None;

D. A. Pappas,
None;

K. C. Saunders,

Corrona,

3;

G. Reed,

Corrona,

5,

Corrona,

2;

S. Grant,

Axio Research LLC,

3;

C. O. Bingham III,

Roche, Genentech, Biogen/IDEC,

2,

Roche, Genentech,

5.

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