Background/Purpose:

Rheumatoid arthritis is a chronic inflammatory process involving progressive destruction of joints.

Currently, 30% of rheumatoid arthritis (RA) patients are over the age of 65. As the population ages, shifts in epidemiology and disease patterns will require an appropriate response from the healthcare system. Elderly patients frequently have more active disease; however, inequalities in prescribing patterns may favor more aggressive treatment in younger patients. There are myriad different reasons why this may be the case; elderly patients tend to have a higher number of comorbidities, more medications, and a greater degree of frailty.

Elderly patients with RA benefit from tight disease control and use of biologic Disease Modifying Anti-rheumatic Drugs (boDMARDs) minimizes the need for other medications. There is a growing body of evidence suggesting that patient outcomes do not significantly decline with age. The reluctance to use boDMARDs in the elderly from concerns around side effects paradoxically means these patients may be exposed to much more deleterious drugs such as glucocorticoids, narcotics, and NSAIDs that may be less desirable in the elderly population.

This study identified differences in biologic prescribing patterns between young (<65 years old) and elderly (> 65 years old) patients with RA. Secondary outcomes examined demographic variation and disease activity between patient age groups.

Methods:

A retrospective cohort study of 1581 patients was conducted using information collected from the Rheumatoid Arthritis Pharmacovigilance Program and Outcomes Research in Therapeutics (RAPPORT) Database. This database encompasses an inception cohort of all RA patients in Northern Alberta starting treatment with biologics.

Fisher’s exact test was used to determine the age of RA patients at first boDMARD prescription using the cutoff of young (<65 years old) and elderly (> 65 years old).

Wilcoxon-Mann-Whitney test was used to stratify disease activity in different age groups using the Health Assessment Questionnaire (HAQ) and Disease Activity Score (DAS28).

Results:

A significantly larger proportion of young RA patients were prescribed boDMARDs compared with elderly RA patients (96.8% vs 90.0%; p = 0.006). Elderly patients prescribed boDMARDs had significantly higher HAQ (mean 1.69 +/- 0.66; p = 0.001) and DAS28 (mean 6.0 +/- 1.68; p = 0.002) scores compared to younger patients (mean 1.41 +/- 0.72 and mean 5.29 +/- 1.7, respectively)

There was no statistically significant difference in other demographic information including sex, ethnicity, and years of schooling.

Conclusion:

Despite current guidelines recommending early, aggressive disease control including the timely introduction of boDMARDs, this study suggests that a prescribing bias remains. Younger patients with lower levels of disease activity are more likely to receive biologic therapies than their elderly counterparts. While there was no statistically significant difference between the basic demographics of each cohort, patient’s level of frailty and comorbid conditions were not accounted for in this study.

« Back to 2017 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/biologic-dmard-prescribing-patterns-in-elderly-patients-with-rheumatoid-arthritis/