Background/Purpose Early introductions of biologics in early rheumatoid arthritis (RA) patients are well documented, but there are few reports of biologics use in established elderly RA patients. We used etanercept (ETN), which has a short half-life and was considered safe, for elderly RA patients who had many complications.

Methods Out of 330 patients treated with ETN at Niigata Rheumatic Center from May 2008 to June 2013, clinical course and data of the patients who started ETN at 75 years old (YO) or older were analyzed. Tender joint counts (TJC) and swollen joint counts (SJC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), matrix metalloprotease-3 (MMP-3), rheumatoid factor (RF), Disease Activity Score for 28-joint counts based on ESR (DAS28-ESR), simplified disease activity index (SDAI), and major adverse events were obtained from their medical records.  The efficacy and safety of ETN was evaluated at 24 months.

Results Forty five patients (17 males, 28 females), a mean age of 79.0 ±2.9 YO and a mean disease duration of 17.0±10.2 years were analyzed. Eighty four point four percent of them had complications such as hypertension, diabetes mellitus, osteoporosis, interstitial pneumonia, or amyloidosis. ETN was used at a dose of 20 mg/week in 1 patient, 25 mg/week in 31, 50 mg/week in 13. Twenty six percent of the patients did not inject by themselves and were injected by family or by the general practitioners. Prophylaxis of tuberculosis (TB), pneumococcal pneumonia (PP), pneumocystis jiroveci pneumonia (PCP) were done in 64%, 40%, and 62 % respectively. TJC, SJC, CRP, ESR, MMP-3 and RF decreased significantly as follows: TJC, 6.3±4.77 to 3.1±3.34 (P < 0.01); SJC, 5.1±4.57 to 2.1±2.53 (P < 0.01); ESR, 54.2±19.48 mm/h to 34.5±24.25 mm/h (p < 0.01); CRP, 4.3±3.19 mg/dL to 1.2±1.68 mg/dL (p < 0.01); MMP-3, 330.7±236.44 ng/mL to 212.7±123.81 ng/mL (p < 0.05); RF, 189.4±219.67 IU/mL to 117.5±140.38 IU/mL (p < 0.05); DAS28-4[ESR], 5.3±1.18 to 3.9±1.33 (p < 0.01); SDAI, 27.3±12.63 to 12.0±9.08 (p < 0.01) (Last Observation Carried Forward). Thirty four percent of the patients achieved remission or low disease activity score and 50% achieved them by SDAI.  Adverse events occurred in 10 patients. Six patients stopped ETN and 4 out of them had infection. One patient (85YO) died due to TB and another (80YO) died due to PCP.

Conclusion We considered that ETN is an effective end relatively safe treatment  for elderly RA patients. Prevention of TB, PP and PCP should be done in all elderly patients treated with ETN.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/efficacy-and-safety-of-etanercept-in-rheumatoid-arthritis-patients-over-75-years-old/