Date: Monday, October 22, 2018
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Elderly patients with rheumatoid arthritis (RA) have declined physical performances and increased various complications. We are concerned about decrease of efficacy and increase of adverse events in elderly RA patients treated with biologic disease-modifying anti rheumatic drugs (bDMARDs) under conditions of insufficient dose of MTXor increased risk of infections. The purpose of this study is to examine the efficacy, safety and adherence of bDMARDs including infliximab (IFX), tocilizumab (TCZ) and abatacept (ABT) in elderly patients with RA.
Methods: RA patients (n=253) who received IFX (n=73), TCZ (n=104) or ABT (n=76) in Saitama Medical University Hospital between 2008 and 2016 were divided into 2 groups. The younger group consists of patients with younger than 64 years old (n=158) and the elderly one over 65 years old (n=95). In these 2 groups, we analyzed retrospectively the patients’ background, disease activity, physical performance, safety and continuation rate of those bDMARDs.
Results: The patients’ background (younger/elderly, p value) was as follows; mean age of onset (44/61 year-old, p<0.001), rate of female (75.3/81.1%), naïve rate of bDMARDs (54.4/46.3%), mean disease duration (6.9/10.5 years, p=0.001), rate of MTX use (82.9/46.3% p<0.001), rate of PSL use (55.7/75.8% p=0.001), mean dose of MTX (7.3/3.7mg/week p<0.001), mean dose of PSL (3.3/3.9mg/day), CDAI (22.3/20.9), DAS28-ESR4 (5.37/5.49), HAQ-DI (1.03/1.56 p<0.001), positive rate of RF (79.3/87.9%) and positive rate of anti-CCP antibody (83.9/93%). In efficacy, CDAI and HAQ significantly decreased in both groups during one year after bDMARDs exposure (P<0.001). There was no significant difference in the prevalence of patients who achieved remission by CDAI between the groups (younger vs. elderly: 30.5% vs. 22.2%). The continuation rate of bDMARDs in elderly patients did not inferior to that in younger patients (82% vs 79%). Moreover, we could not find significant difference in continuation rate of each 3 bDMARDs between the 2 groups (younger vs. elderly: IFX 75% vs. 77%, TCZ 83% vs. 84%, ABT 89% vs. 75%). The reasons for bDMARDs discontinuation within one year (younger/elderly) were adverse events (8.2/14.7％), ineffective (10.1/5.3％) and remission (0.0/1.1％).
Conclusion: The efficacy, safety and adherence of bDMARDs in elderly patients were not inferior to those in younger patients. These results suggest that the utility of bDMARDs would not be affected by age.
To cite this abstract in AMA style:Wada TT, Asanuma YF, Matsuda M, Yazawa H, Nakao Y, Kozu N, Mimura T. The Efficacy, Safety and Adherence of Biologicbiological Disease-Modifying Anti Rheumatic Drugs, Infliximab, Tocilizumab and Abatacept, in Elderly Patients with Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/the-efficacy-safety-and-adherence-of-biologicbiological-disease-modifying-anti-rheumatic-drugs-infliximab-tocilizumab-and-abatacept-in-elderly-patients-with-rheumatoid-arthritis/. Accessed May 29, 2020.
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