ATLANTA — Biologic DMARDs were as efficacious among patients with rheumatoid arthritis aged 60 years and older at disease onset as it was among younger patients, with comparable rates of drug maintenance and adverse event discontinuation between the two groups, according to findings presented at the 2019 ACR/ARP Annual Meeting.
“Elderly-onset patients with RA can present with higher disease activity and increased disabilities as compared to young-onset RA patients,” Sadao Jinno, MD, MSc, instructor of rheumatology at Kobe University Graduate School of Medicine, Japan, said during a press conference. “Also, prior studies show that [elderly patients] receive biologics less frequently than those with young-onset RA. This could be an issue for some of the patients with elderly-onset RA because they can have some problems with daily activity functions — they may not get biologics at the right time — and the dysfunction can worsen.”
“On the other hand, in my daily practice, I see a lot of patients with elderly-onset RA who are treated with biologics very effectively and safely,” he added. “We wanted to see if there were really any differences between the elderly-onset patients and the young-onset patients in the bigger scale.”
According to data presented by Sadao Jinno, MD, MSc at ACR/ARP, both patients with RA whose disease onset occurred at an older age and those whose disease onset occurred earlier in life had similar improvements in clinical disease at 48 weeks after starting biologic DMARDs.
To determine whether efficacy and safety differences existed between patients with elderly-onset RA and young-onset RA receiving biologic DMARDs, Jinno and colleagues assessed patients with RA (n = 7,183) who had a DAS28-ESR score of 3.2 or greater in a multicenter, observational registry from September 2009 to December 2017. The researchers defined elderly-onset RA as disease onset at 60 years or older.
Jinno and colleagues established clinical disease activity index (CDAI) score between the two groups at 48 weeks as the primary outcome, with secondary outcomes including biologic retention at 48 weeks, achievement of a CDAI remission and low disease activity, or remission.
According to study results — although the proportion of patients with elderly-onset RA administered biologic DMARDs was significantly lower than patients with young-onset RA (18.3% vs. 28%; P < .001) — following adjustment for baseline characteristics, there was no significant difference in CDAI score at 48 weeks (1.01; 95% CI, –0.62 to 2.64).
Additionally, the researchers did report a trend toward lower remission rates among early-onset patients (OR = 0.52; 95% CI, 0.24-1.14), but the low-disease activity/remission rate was similar between the groups after adjusting for multiple confounders (OR = 0.86; 95% CI, 0.29-2.52). Likewise, drug maintenance rates (HR = 0.95; 95% CI, 0.55-1.35) and adverse events discontinuation rates (HR = 0.78; 95% CI, 0.38-1.18) were also comparable following this adjustment.
“Older patients can be treated as effectively and safely as younger RA patients. Age could be just a number,” Jinno said. “If necessary, given the right timing, elderly patients with RA should be treated with biologics.”– by Robert Stott
Jinno S. Abstract #1345. Are there differences in efficacy and safety of biological disease-modifying antirheumatic drugs between elderly-onset and young-onset rheumatoid arthritis? Presented at ACR/ARP Annual Meeting, Nov. 8-13, 2019; Atlanta.
Disclosure: Jinno reports no relevant financial disclosures.