Are There Differences in Efficacy and Safety of Biological Disease-modifying Antirheumatic Drugs Between Elderly-onset and Young-onset Rheumatoid Arthritis?

Sadao Jinno¹, Akira Onishi ², Kengo Akashi ², Motomu Hashimoto ³, Wataru Yamamoto ³, Koichi Murata ³, Tohru Takeuchi ⁴, Takuya Kotani ⁴, Yuichi Maeda ⁵, Kosuke Ebina ⁶, Yonsu Son ⁷, Hideki Amuro ⁷, Ryota Hara ⁸, Masanori Katayama ⁹, Jun Saegusa ² and Akio Morinobu ², ¹Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Osaka, Japan, ²Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Kobe, Japan, ³Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan, ⁴Department of Internal Medicine IV, Osaka Medical College, Osaka, Japan, ⁵Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Osaka, Japan, ⁶Department of Musculoskeletal Regenerative Medicine, Osaka University, Graduate School of Medicine, Osaka, Japan, ⁷First Department of Internal Medicine, Kansai Medical University, Osaka, Japan, ⁸The Center for Rheumatic Disease, Department of Orthopedic Surgery, Nara Medical University, Nara, Japan, ⁹Department of Rheumatology, Osaka Red Cross Hospital, Osaka, Japan

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: Biologic agents and remission, Elderly, Rheumatoid arthritis (RA)

Session Information

Date: Monday, November 11, 2019

Title: RA – Diagnosis, Manifestations, & Outcomes Poster II: Treatments, Outcomes, & Measures

Session Type: Poster Session (Monday)

Session Time: 9:00AM-11:00AM

Background/Purpose:

To compare efficacy and safety of biological disease-modifying antirheumatic drugs (bDMARDs) between elderly-onset rheumatoid arthritis (EORA) and young-onset rheumatoid arthritis (YORA) patients.

Methods: Patients with rheumatoid arthritis (RA) aged ≧18 years enrolled in a Japanese multicenter observational registry between Sep 2009 and December 2017 who had ≧3.2 disease activity score in 28 joints-erythrocyte sedimentation rate (DAS28-ESR) when initiating bDMARDs were included. EORA was defined as RA with onset at 60 or over. Considering selection bias in the estimation of effects of time-varying treatments and clustering effects by individual, a generalized estimating equation model with an inverse probability of treatment weighting was used to assess the relationship between age onset and clinical effectiveness at 48 weeks. Primary outcome was Clinical Disease Activity Index (CDAI) score at 48 weeks. Secondary outcomes included biologic retention at 48 weeks, achievement of CDAI remission, and low disease activity (LDA)/remission. Biologic retention rate was compared using a cox proportional hazards model.

Results: Among a total of 7183 patients in the registry, proportion of patients on bDMARDs was lower in the EORA as compared to the YORA (18.3 % vs 28.0 %, p < 0.001). Of the 989 bDMARDs initiators, 364 (36.8%) were identified as EORA. After adjusting for differences in baseline characteristics between the two age groups, there was no significant difference in CDAI score at 48 weeks (1.01, 95% CI=-0.62-2.64, p=0.22). There was a trend of lower remission in the EORA (OR=0.52, 95%CI=0.24-1.14, p=0.10), but LDA/remission rate was similar (OR=0.86, 95%CI=0.29-2.52, p=0.77). Drug maintenance rates (HR=0.95, 95%CI=0.55-1.35, p=0.78) and adverse events discontinuation rates (HR=0.78, 95%CI=0.38-1.18, p=0.22) were similar between the two age groups adjusting other confounders.

Conclusion: In RA patients initiating bDMARDs, improvements in clinical disease at 48 weeks were comparable between EORA and YORA. Drug maintenance and adverse events discontinuation rates were similar between the two age groups.

EORA table 1 PDF

Disclosure: S. Jinno, None; A. Onishi, None; K. Akashi, None; M. Hashimoto, Astellas, 8, Ayum, 9, Brystol-Meyers, 8, Chugai, 9, Tanabe-Mitsubishi, 8, 9, UCB Japan, 9; W. Yamamoto, None; K. Murata, Eisai Co., Ltd, 8; T. Takeuchi, AbbVie, 8, AbbVie GK., 8, Asahi Kasei, 8, Astellas, 8, Astellas Pharma, 8, 9, AYUMI Pharmaceutical Co, 8, AYUMI Pharmaceutical Co., 9, Bristol Myers Squibb,, 8, Bristol-Myers, 8, Chugai Pharmaceutical Co. Ltd, 2, 8, 9, Daiichi Sankyo Co. Ltd, 8, Daiichi Sankyo Co. Ltd., 8, Eisai C o., Ltd., 8, 9, Eisai Co., Ltd, 8, Mitsubishi Tanabe Pharma Corporation, 8, 9, Takeda Pharmaceutical Company, 8, Takeda Pharmaceutical Company Limited, 8, 9; T. Kotani, None; Y. Maeda, Bristol-Myers Squibb Company, 8, Chugai Pharmaceutical Co. Ltd, 8, Eli Lily, 8, Mitsubishi-Tanabe, 8, Pfizer, 8; K. Ebina, Abbvie, 8, Asahi-Kasei, 8, Astellas, 8, Bristol-Myers, 8, Chugai, 8, Daiichi Sankyo, 8, Eisai, 8, Eli Lily, 8, Mitsubishi-Tanabe, 8, Ono Pharmaceutical, 8, Pfizer, 8, UCB Japan, 8; Y. Son, None; H. Amuro, None; R. Hara, None; M. Katayama, None; J. Saegusa, None; A. Morinobu, None.

To cite this abstract in AMA style:

Jinno S, Onishi A, Akashi K, Hashimoto M, Yamamoto W, Murata K, Takeuchi T, Kotani T, Maeda Y, Ebina K, Son Y, Amuro H, Hara R, Katayama M, Saegusa J, Morinobu A. Are There Differences in Efficacy and Safety of Biological Disease-modifying Antirheumatic Drugs Between Elderly-onset and Young-onset Rheumatoid Arthritis? [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/are-there-differences-in-efficacy-and-safety-of-biological-disease-modifying-antirheumatic-drugs-between-elderly-onset-and-young-onset-rheumatoid-arthritis/. Accessed .

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