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Uslu S, Gülle S, Urak Ö, Şen G, Dalkılıç E, Şenel S, Akar S, İnanç N, Cefle A, Köken Avşar A, Yolbaş S, Yılmaz S, Soysal Gündüz Ö, Sarı İ, Birlik M, Akkoç N, Önen F. Biological treatment in elderly and young patients with ankylosing spondylitis: TURKBIO real-life data results. Arch Rheumatol 2024; 39:232-241. [PMID: 38933720 PMCID: PMC11196228 DOI: 10.46497/archrheumatol.2024.10391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 11/02/2023] [Indexed: 06/28/2024] Open
Abstract
Objectives This study aims to investigate the effect of age on disease activity and biological treatment in patients with ankylosing spondylitis (AS). Patients and methods A total of 811 AS patients registered in the TURKBIO registry database between 2011 and 2019 were categorized according to their age at the time of entry into the registry and assigned to one of two groups: young patients, defined as <60 years of age (n=610), and those aged ≥60 years (n=201) were recorded as elderly patients. Demographic, clinical, and laboratory characteristics, along with disease activity markers and other follow-up parameters, as well as current and prior treatments, were electronically recorded during each visit using open-source software. Results The mean age of the elderly patients was 67±5.8 years, while the mean age of the younger patients was 49.2±10.9 years. Male predominance was lower in the older AS group compared to the younger AS group (p=0.002). During follow-up period, 397 patients (comprising 318 young and 79 elderly individuals) had a history of using at least one biological disease-modifying agent (bDMARD). There was no significant difference between the groups in terms of DMARD and bDMARD-use distributions. First tumor necrosis factor inhibitor (TNFi) retention rates were found to be similar in both groups over 10 years of follow-up. Adverse events were found to be similar in young (19.9%) and elderly (26.8%) AS patients. Conclusion Research in the TURKBIO cohort reveals that both older and younger patients with AS exhibited similar disease activity levels with comparable treatment approaches. Moreover, the results of TNFi treatments in elderly patients were the same as those observed in younger patients, with no notable increase in safety concerns.
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Affiliation(s)
- Sadettin Uslu
- Department of Internal Medicine, Division of Rheumatology, Celal Bayar University Faculty of Medicine, Manisa, Türkiye
| | - Semih Gülle
- Department of Internal Medicine, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, Izmir, Türkiye
| | - Özkan Urak
- Department of Internal Medicine, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, Izmir, Türkiye
| | - Gerçek Şen
- Department of Internal Medicine, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, Izmir, Türkiye
| | - Ediz Dalkılıç
- Department of Internal Medicine, Division of Rheumatology, Uludağ University Faculty of Medicine, Bursa, Türkiye
| | - Soner Şenel
- Department of Internal Medicine, Division of Rheumatology, Erciyes University Faculty of Medicine, Kayseri, Türkiye
| | - Servet Akar
- Department of Internal Medicine, Division of Rheumatology, Katip Çelebi University Faculty of Medicine, Izmir, Türkiye
| | - Nevsun İnanç
- Department of Internal Medicine, Division of Rheumatology, Marmara University Faculty of Medicine, Istanbul, Türkiye
| | - Ayşe Cefle
- Department of Internal Medicine, Division of Rheumatology, Kocaeli University Faculty of Medicine, Kocaeli, Türkiye
| | - Aydan Köken Avşar
- Department of Internal Medicine, Division of Rheumatology, Kocaeli City Hospital, Kocaeli, Türkiye
| | - Servet Yolbaş
- Department of Internal Medicine, Division of Rheumatology, İnönü University Faculty of Medicine, Malatya, Türkiye
| | - Sema Yılmaz
- Department of Internal Medicine, Division of Rheumatology, Selçuk University Faculty of Medicine, Konya, Türkiye
| | - Özgül Soysal Gündüz
- Department of Internal Medicine, Division of Rheumatology, Celal Bayar University Faculty of Medicine, Manisa, Türkiye
| | - İsmail Sarı
- Department of Internal Medicine, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, Izmir, Türkiye
| | - Merih Birlik
- Department of Internal Medicine, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, Izmir, Türkiye
| | - Nurullah Akkoç
- Department of Internal Medicine, Division of Rheumatology, Celal Bayar University Faculty of Medicine, Manisa, Türkiye
| | - Fatoş Önen
- Department of Internal Medicine, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, Izmir, Türkiye
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Pérez N, Gargiulo MDLÁ, Khoury M, Suárez L, Correa MDLÁ, Pera M, Saravia N, Gómez G. Elderly-onset rheumatoid arthritis receives less aggressive therapies than young-onset rheumatoid arthritis in an Argentinian cohort. REUMATOLOGIA CLINICA 2024; 20:136-141. [PMID: 38443231 DOI: 10.1016/j.reumae.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/26/2023] [Indexed: 03/07/2024]
Abstract
OBJECTIVES When rheumatoid arthritis (RA) starts after the age of 60 it is called elderly-onset rheumatoid arthritis (EORA) and when it starts earlier, young-onset rheumatoid arthritis. (YORA). There are few Latin American studies that compared both groups. The objective of the study was to evaluate differences in the clinical characteristics, evolution and treatment among patients with RA with onset before or after 60 years of age. MATERIALS AND METHODS Observational study of patients with RA attended consecutively in four centers in Argentina. Sociodemographic data, comorbidities, clinical manifestations at diagnosis, presence of rheumatoid factor and/or anti-CCP (cyclic citrullinated peptide) and treatments received were collected. At the last visit, swollen and tender joints, assessment of disease activity by the patient and physician, the presence of radiographic erosions, and functional status using the HAQ-DI were recorded. RESULTS 51 patients from each group were analyzed. The EORA group had a significantly higher proportion of smokers (58.8% vs. 35.3%, p = 0.029), cardiovascular history (54.9% vs. 21.6%, p = 0.001), abrupt onset (49% vs. 29.4%, p = 0.034) or with symptoms similar to PMR (19.6% vs. 0%, p = 0.001). Lower methotrexate doses were used in the EORA group: 19 mg (15-25) vs. 21.9 mg (20-25) (p = 0.0036) and more frequently did not receive bDMARDs or tsDMARDs. DISCUSSION AND CONCLUSIONS The benefits of intensive treatment in patients with RA have been described. In this study, the use of DMARDs in the EORA group was less intensive, suggesting that advanced age constitutes a barrier in the therapeutic choice.
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Affiliation(s)
- Nicolás Pérez
- Servicio de Inmunología, Instituto de Investigaciones Médicas "Dr. Alfredo Lanari", Ciudad Autónoma de Buenos Aires, Argentina.
| | - María de Los Ángeles Gargiulo
- Servicio de Inmunología, Instituto de Investigaciones Médicas "Dr. Alfredo Lanari", Ciudad Autónoma de Buenos Aires, Argentina.
| | - Marina Khoury
- Docencia e Investigación, Instituto de Investigaciones Médicas "Dr. Alfredo Lanari", Ciudad Autónoma de Buenos Aires, Argentina.
| | - Lorena Suárez
- Servicio de Inmunología, Instituto de Investigaciones Médicas "Dr. Alfredo Lanari", Ciudad Autónoma de Buenos Aires, Argentina.
| | | | - Mariana Pera
- Servicio de Reumatología, Hospital Ángel Cruz Padilla, San Miguel de Tucumán, Tucumán, Argentina.
| | - Natali Saravia
- Servicio de Reumatología, Hospital Tornú, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Graciela Gómez
- Servicio de Inmunología, Instituto de Investigaciones Médicas "Dr. Alfredo Lanari", Ciudad Autónoma de Buenos Aires, Argentina.
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Novella-Navarro M, Balsa A. Difficult-to-Treat Rheumatoid Arthritis in Older Adults: Implications of Ageing for Managing Patients. Drugs Aging 2022; 39:841-849. [PMID: 36104655 PMCID: PMC9626415 DOI: 10.1007/s40266-022-00976-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 11/30/2022]
Abstract
Difficult-to-treat rheumatoid arthritis is a heterogeneous term in which patients may present with difficulties in their management for different reasons. This can ultimately lead to patients being exposed to multiple treatments because of inefficacy (resulting from mechanisms intrinsic to rheumatoid arthritis or from non-inflammatory causes such as chronic pain syndrome or structural damage, among others), toxicity or adverse effects that may be linked to comorbidities. One particular group in which such characteristics may be more patent is older patients. Increasing life expectancy, an ageing population and the late onset of rheumatoid arthritis have led to an increased interest in the particularities of treating older patients. This may pose a challenge for physicians, as ageing has implications for optimal patient treatment owing to the potential presence of comorbidities, the risk of adverse events and perceptions of disease status by both physicians and patients. All of these factors may have implications for classifying and managing patients aged > 65 years as difficult-to-treat rheumatoid arthritis, as these patients could be misclassified. This can occur when a significant proportion may still exhibit signs of active disease but not necessarily be difficult to treat because the treatment criterion has not been fulfilled. Alternatively, patients may be exposed to multiple biologic/targeted disease-modifying antirheumatic drugs because of contraindications and/or comorbid conditions. Treatment-to-target strategies and an adequate assessment of inflammatory rheumatoid arthritis activity in older patients should be undertaken, taking special care with associated comorbidities, polypharmacy and risk profiles. Such an approach can help to ensure appropriate treatment for older adults and avoid the misclassification of difficult-to-treat patients.
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Affiliation(s)
| | - Alejandro Balsa
- Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain
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Kurosawa Y, Ito S, Sakai S, Hasegawa E, Kobayashi D, Abe A, Otani H, Nakazono K, Murasawa A, Narita I, Ishikawa H. Effectiveness and Safety of Golimumab for Patients ≥75 Years Old with Rheumatoid Arthritis. Intern Med 2022; 61:2117-2125. [PMID: 35850986 PMCID: PMC9381335 DOI: 10.2169/internalmedicine.8497-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective Treatment of elderly patients with rheumatoid arthritis (RA) has been controversial because they often have serious comorbidities and cannot use methotrexate (MTX). In Japan, golimumab (GLM) 100 mg without MTX is approved. We investigated the effectiveness and safety of GLM in elderly patients with RA. Methods The GLM survival rate was evaluated using the Kaplan-Meier method. Disease activities, laboratory findings, and treatments were evaluated. Patients We enrolled 168 patients with RA in our hospital. Using age ≥75 years old to identify elderly patients, younger (n=111) and elderly (n=57) groups were established. Elderly patients were divided into 2 groups according to the MTX treatment status (with, n=27; without, n=25). Results The GLM survival rates were 80.8% and 82.3% in elderly and younger patients, respectively (p=0.762). At 52 weeks, the Disease Activity Score 28-erythrocyte sedimentation rate (DAS28-ESR) was improved in elderly patients (4.26 vs. 3.31, p<0.001); the Health Assessment Questionnaire Disability Index (HAQ-DI) was unchanged (1.12 vs. 0.88, p=0.694). When elderly patients were compared according to the MTX treatment status, the DAS28-ESR had improved in both groups (with MTX: 3.82 vs. 2.68, p<0.001; without MTX: 4.76 vs. 4.25, p=0.026); however, the HAQ-DI had not. The GLM survival rates at 52 weeks were 85% and 76% in patients with and without MTX, respectively. Conclusion In elderly patients with RA, GLM was effective, regardless of MTX treatment status, but it did not affect the HAQ-DI. GLM survival rates were comparable between elderly and younger patients. GLM may be a suitable option for elderly patients with RA who cannot use MTX.
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Affiliation(s)
- Yoichi Kurosawa
- Department of Rheumatology, Niigata Rheumatic Center, Japan
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Satoshi Ito
- Department of Rheumatology, Niigata Rheumatic Center, Japan
| | - Shunsuke Sakai
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Eriko Hasegawa
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Daisuke Kobayashi
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Asami Abe
- Department of Rheumatology, Niigata Rheumatic Center, Japan
| | - Hiroshi Otani
- Department of Rheumatology, Niigata Rheumatic Center, Japan
| | | | - Akira Murasawa
- Department of Rheumatology, Niigata Rheumatic Center, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Japan
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Mathieu S, Pereira B, Saraux A, Richez C, Combe B, Soubrier M. Disease-modifying drug retention rate according to patient age in patients with early rheumatoid arthritis: analysis of the ESPOIR cohort. Rheumatol Int 2021; 41:879-885. [PMID: 33433729 DOI: 10.1007/s00296-020-04770-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/08/2020] [Indexed: 10/22/2022]
Abstract
Physicians are sometimes hesitant to use disease-modifying antirheumatic drugs (DMARDs) in elderly patients with rheumatoid arthritis (RA), as they are deemed too fragile, although there are no sufficient scientific evidence. We aimed to compare DMARD treatment retention in early RA patients from the ESPOIR cohort, according to age upon inclusion. Overall, treatment retention was evaluated as the percentage of patients whose DMARDs were not stopped, with stratification by age group: < 50, 50-64, and > 65 years. Survival curves were measured using the Kaplan-Meier method. Of the entire ESPOIR cohort (n = 813), 7% were > 65 years old. Methotrexate (MTX) was used by 521 patients, and was the sole DMARD for 198 patients. MTX treatment retention appeared better in patients > 65 years old compared to < 50 years old [HR 0.45 (0.25; 0.81); p = 0.008, n = 195/198] with adjustment on sex, smoking, positive anti-cyclic citrullinated peptide antibodies, positive rheumatoid factor, body mass index, changes in DAS28 and corticosteroid treatment. The proportion of patients using etanercept (n = 111), and this drug's retention rate, did not differ according to patient age. The proportion of patients treated with adalimumab (n = 104) was significantly higher in patients < 50 years old (p = 0.003), and treatment retention was marginally better among younger patients [HR 1.68 (0.88; 3.22), p = 0.12]. Within the ESPOIR cohort, DMARD retention did not appear to differ according to age-except for better retention of MTX treatment in patients 50-64 years old, and of adalimumab in patients < 50 years old.
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Affiliation(s)
- S Mathieu
- Rheumatology Department, CHU Gabriel Montpied, Clermont 1 University, Clermont-Ferrand, France.
| | - B Pereira
- Department of Clinical Research and Innovation (DRCI), University Hospital of Clermont-Ferrand (CHU), Clermont-Ferrand, France
| | - A Saraux
- Department of Rheumatology, Brest University Hospital, Brest, France
| | - C Richez
- Rheumatology Department, CHU Pellegrin, Bordeaux, France
| | - B Combe
- Département de Rhumatologie, CHU Montpellier, Université de Montpellier, Montpellier, France
| | - M Soubrier
- Rheumatology Department, CHU Gabriel Montpied, Clermont 1 University, Clermont-Ferrand, France
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Dalal DS, Zhang T, Shireman TI. Medicare expenditures for conventional and biologic disease modifying agents commonly used for treatment of rheumatoid arthritis. Semin Arthritis Rheum 2020; 50:822-826. [PMID: 32896694 PMCID: PMC7453205 DOI: 10.1016/j.semarthrit.2020.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/17/2020] [Accepted: 08/04/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Biologic disease modifying agents (bDMARDs) are an integral part of rheumatoid arthritis treatment guidelines but are associated with significant cost in the US. We present the trends in total spending and unit cost of conventional DMARDs (cDMARDs) as compared to bDMARDs in Medicare program. METHODS We used the Medicare drug spending data for the year 2012-2017 covering all part B (fee-for-service) and part D drugs. Total spending was calculated by summing spending across various drug formulations and unit drug cost by dividing total spending by number of doses dispensed. We present the 6-year trends in total spending, total beneficiary count and unit costs of each of the commonly used cDMARDs and bDMARDs. RESULTS Between 2012 and 2017, the total spending on the cDMARDs increased 5-folds from $98 million to $579 million; this was fraction of total spending on bDMARDs which increased from $4.3 to $10.0 billion. This increase was driven largely by unit costs of drug rather than number of beneficiaries. There was a 6-fold increase in the unit cost of generic hydroxychloroquine followed by methotrexate and leflunomide. Amongst bDMARDs, adalimumab and etanercept unit cost increased by 2-folds. The increase was less pronounced for office-administered products. CONCLUSIONS Despite the availability of several generic cDMARDs over decades, there were steep increases in the unit cost of these agents to "keep pace" with the increases in bDMARDs. As the number of elderly rheumatoid arthritis patients increases, policy interventions might be required to reduce the spending on both biologics and conventional DMARDs.
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Affiliation(s)
- Deepan S Dalal
- Division of Rheumatology, Department of Medicine, Brown University School of Medicine, Providence, RI, USA; Department of Health Services, Policy and Practices, Brown University School of Public Health, Providence, RI, USA.
| | - Tingting Zhang
- Department of Health Services, Policy and Practices, Brown University School of Public Health, Providence, RI, USA
| | - Theresa I Shireman
- Department of Health Services, Policy and Practices, Brown University School of Public Health, Providence, RI, USA
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Norvang V, Brinkmann GH, Yoshida K, Lillegraven S, Aga AB, Sexton J, Tedeschi SK, Lyu H, Norli ES, Uhlig T, Kvien TK, Mjaavatten MD, Solomon DH, Haavardsholm EA. Achievement of remission in two early rheumatoid arthritis cohorts implementing different treat-to-target strategies. Arthritis Rheumatol 2020; 72:1072-1081. [PMID: 32090491 DOI: 10.1002/art.41232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/06/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To compare achievement of remission in two early rheumatoid arthritis (RA) treat-to-target (TTT) cohorts, one tight control cohort targeting stringent remission in a randomized controlled strategy trial and one observational cohort targeting a looser definition of remission in clinical practice. METHODS We analyzed data from the ARCTIC trial and the NOR-VEAC observational study. Both were Norwegian multicenter studies including disease modifying anti-rheumatic drug (DMARD)-naïve RA-patients and implementing TTT. The target in ARCTIC was remission defined as a Disease Activity Score (DAS44) <1.6 plus 0 of 44 swollen joint count, while the target in NOR-VEAC was the less stringent remission of DAS28<2.6. We assessed achievement of the study-specific targets and compared achievement of the ACR/ EULAR Boolean remission during two years of follow-up. RESULTS We included 189 patients from ARCTIC and 330 patients from NOR-VEAC. More than half in each cohort had reached the study-specific target at 6 months, increasing to more than 60% at 12 and 24 months. The odds of reaching ACR/EULAR Boolean remission during follow-up were higher in ARCTIC than in NOR-VEAC, with statistically significant differences at 3 months (OR 1.73; 95% CI 1.03-2.89), 12 months (OR 1.97; 95% CI 1.21-3.20) and 24 months (OR 1.82; 95% CI 1.05 - 3.16). CONCLUSION A majority of patients in both cohorts reached the study-specific treatment targets. More patients in ARCTIC than in NOR-VEAC achieved ACR/EULAR Boolean remission during follow-up, suggesting that targeting a more stringent definition of remission provide further potential for favorable outcomes of a TTT strategy.
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Affiliation(s)
- Vibeke Norvang
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Kazuki Yoshida
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women´s Hospital, Boston, USA
- Harvard Medical School, Boston, USA
| | - Siri Lillegraven
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | - Joseph Sexton
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Sara K Tedeschi
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women´s Hospital, Boston, USA
- Harvard Medical School, Boston, USA
| | - Houchen Lyu
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ellen S Norli
- Department of Rheumatology, Martina Hansens Hospital, Sandvika, Norway
| | - Till Uhlig
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Daniel H Solomon
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women´s Hospital, Boston, USA
- Harvard Medical School, Boston, USA
| | - Espen A Haavardsholm
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Department of Rheumatology, Østfold Hospital, Grålum, Norway
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Efficacy and Safety of Etanercept in Elderly Patients with Rheumatoid Arthritis: A Post-Hoc Analysis of Randomized Controlled Trials. Drugs Aging 2019; 36:853-862. [PMID: 31292906 DOI: 10.1007/s40266-019-00691-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Elderly individuals are disproportionately affected by rheumatoid arthritis (RA), but few studies have addressed the efficacy and safety of treatments in this population. OBJECTIVE Our objective was to assess the efficacy and safety of etanercept in elderly patients (aged ≥ 65 years) with RA. METHODS The efficacy analysis was a post hoc analysis of data from the open-label period of three phase IV clinical trials of etanercept for RA. Least squares (LS) change from baseline (cfb) in 28-joint Disease Activity Score (DAS28), Health Assessment Questionnaire Disability Index (HAQ-DI), and modified Total Sharp Scores (mTSS) were analyzed by age (< 65 vs. ≥ 65 years) for each study. The safety analyses were of data pooled from the double-blind, placebo-controlled periods of 19 phase I-IV randomized studies of etanercept in patients with RA. The percentage occurrence of adverse events (AEs) in placebo- and etanercept-treated patients was analyzed by age (< 65 vs. ≥ 65 years). RESULTS There were no significant differences in LS mean cfb in DAS28 or mTSS between the two age groups. LS mean cfb in HAQ-DI scores was consistently lower in elderly than in non-elderly patients, although significant differences were not observed in all trials. Overall, AE occurrence was higher in elderly than non-elderly patients, regardless of treatment. In etanercept-treated patients, there were small yet statistically significant increases in the occurrence of congestive heart failure, serious infections, and non-melanoma skin cancers in elderly versus non-elderly patients. For most AEs, occurrence did not significantly differ between elderly and non-elderly patients. CONCLUSION Overall, there were no substantial differences in the efficacy or safety of etanercept between elderly and non-elderly patients with RA.
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Oishi S, Wendling D, Sibilia J, Job-Deslandre C, Guillevin L, Benichou J, Flipo RM, Duquenne C, Guillemin F, Saraux A. Treatment of active rheumatoid arthritis: comparison of patients younger vs older than 75 years (CORPUS cohort). Hum Vaccin Immunother 2018; 14:2612-2617. [PMID: 30230962 PMCID: PMC6314403 DOI: 10.1080/21645515.2018.1522470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objectives: Little information is available on the characteristics of elderly patients starting TNFα antagonist treatment for rheumatoid arthritis (RA). The objective of this work was to compare prescription patterns in RA patients younger vs. older than 75 years. Methods: Biologic-naive patients with active RA (DAS28 > 3.2) despite first-line therapy were included between 2007 and 2009 in the prospective, multicentre, longitudinal, observational, population-based CORPUS-RA cohort. TNFα antagonist users were defined as having received at least one TNFα antagonist during the first study year. The groups < 75 years and ≥ 75 years were compared regarding comorbidities, inflammation (CRP and ESR), disease activity (DAS28), disability (HAQ-DI), number of physician visits, and treatment. To verify the impact of the cut off, we also compared patients aged 70 years or more to patients younger than 70 years. Results: Of 543 RA patients, 382 had complete one-year follow-up data, including 114 TNFα antagonist users, 3 (6%) among the 49 patients aged 75 years or over and 111 (32%) of the 333 patients younger than 75 years (p < 0.01). Disease activity in the two age groups was similar at inclusion and after one year. Comorbidities and a history of auto-immunity were more common in the older group. Compared to their younger counterparts, the older patients received glucocorticoids more often (p = 0.003) and synthetic disease-modifying anti-rheumatic drugs less often (p = 0.01). Conclusion: TNFα antagonists are used less often and glucocorticoids more often in elderly patients with active RA compared to their younger counterparts. The fact that this study was performed in 2007–9 is a limitation in terms of relevance to today’s patients and further studies should be conducted in new cohorts of active RA.
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Affiliation(s)
- Sachiyo Oishi
- a Rheumatology department , Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), CHU Brest , Brest Cedex , France
| | - Daniel Wendling
- b Rheumatology department , Besançon University Hospital, Boulevard Fleming , Besançon , France.,c EA 4266 , Franche-Comté University , Besançon , France
| | - Jean Sibilia
- d Rheumatology department , Hautepierre University Hospital , Strasbourg , France
| | | | - Loic Guillevin
- f Department of Internal Medicine , Cochin-Paris University Hospital , Paris , France
| | - Jacques Benichou
- g Department of Biostatistics and Clinical Research , Rouen University Hospital , Rouen , France.,h INSERM U1219 , University of Rouen , Rouen , France
| | - René Marc Flipo
- i Rheumatology department , Lille University Hospital , Lille , France
| | - Carole Duquenne
- a Rheumatology department , Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), CHU Brest , Brest Cedex , France
| | - Francis Guillemin
- j INSERM, CIC-EC 1433 , Université de Lorraine, Brabois University Hospital , Vandoeuvre-lès-Nancy , France
| | - Alain Saraux
- k Rheumatology department, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex 'Immunotherapy, Graft, Oncology' , Université de Brest , Brest , Cedex , France
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Dalal DS, Duran J, Brar T, Alqadi R, Halladay C, Lakhani A, Rudolph JL. Efficacy and safety of biological agents in the older rheumatoid arthritis patients compared to Young: A systematic review and meta-analysis. Semin Arthritis Rheum 2018; 48:799-807. [PMID: 30185379 DOI: 10.1016/j.semarthrit.2018.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 06/06/2018] [Accepted: 07/23/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Biologic anti-rheumatic drugs are used with less frequency among older patients compared to young patients. This population is less represented in studies performed to evaluate the efficacy and safety of this drugs. We aimed to assess the efficacy and safety of biological agents between the older RA patients compared to young. METHODS A comprehensive, systematic search was conducted in major indexing databases using key terms for RA and each biological agent. The review process was completed by 2 investigators. Both randomized controlled trials and observational studies of at least 6-month duration conducted in adult RA patients were included. Outcomes of interest were clinical efficacy and safety. Effect-estimates were pooled using random-effects modeling if 4 or more studies used the same scale and time-frame for measuring outcomes. RESULTS 24 studies (16 focusing on anti-TNF agents) representing 63,705 patients (24% were older) were included. Older RA patients had worse baseline RA disease activity, longer disease duration at the time of enrollment in the trial (14.4 ± 3.6 vs. 10.9 ± 3.6 years; p < 0.001) and higher steroid use (73.2 vs. 64.7%, p < 0.001) than younger. 5 out of 6 studies assessing anti-TNF agents showed worse efficacy outcomes in older patients. The pooled OR of infection and ADRs with anti-TNF agents in older compared to young RA patients was OR 1.59 (95% CI: 1.45-1.76) and 1.40 (95% CI: 1.23-1.61) respectively. CONCLUSIONS Older patients had worse safety and efficacy with biological agents but also had worse baseline disease activity. There was significant heterogeneity in reporting outcomes and very limited studies in biological agents other than anti-TNF drugs.
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Affiliation(s)
- Deepan S Dalal
- Warren Alpert School of Brown University, Providence, RI, USA.
| | | | - Tina Brar
- Warren Alpert School of Brown University, Providence, RI, USA
| | - Rasha Alqadi
- Warren Alpert School of Brown University, Providence, RI, USA; Roger Williams Medical Center, Providence, RI, USA
| | - Christopher Halladay
- Center of Innovation in Long Term Services and Supports, Providence VA Medical Center, Providence, RI, USA
| | - Alisha Lakhani
- Warren Alpert School of Brown University, Providence, RI, USA
| | - James L Rudolph
- Warren Alpert School of Brown University, Providence, RI, USA; Center of Innovation in Long Term Services and Supports, Providence VA Medical Center, Providence, RI, USA
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13
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Smets P, Devauchelle-Pensec V, Rouzaire PO, Pereira B, Andre M, Soubrier M. Vascular endothelial growth factor levels and rheumatic diseases of the elderly. Arthritis Res Ther 2016; 18:283. [PMID: 27906058 PMCID: PMC5133736 DOI: 10.1186/s13075-016-1184-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 11/16/2016] [Indexed: 11/28/2022] Open
Abstract
Background Increasing vascular endothelial growth factor (VEGF) has been reported in remitting symmetrical seronegative synovitis with pitting edema (RS3PE) syndrome, rheumatoid arthritis (RA), polymyalgia rheumatica (PMR) and giant cell arteritis (GCA). The aim of this study was to compare VEGF levels in patients over 60 years of age who have RS3PE, RA, PMR or GCA so as to determine whether elevated VEGF is specific for a rheumatic disease, the inflammation or edema that occurs with these pathological conditions. Methods In this retrospective, multicentric study we assessed serum and plasma levels of VEGF in patients over 60 years of age with rheumatic diseases that were either de novo or of recent onset according to the initial clinical presentation, and we compared these patients with a control group. Results Serum and plasma VEGF levels were determined in 80 patients (5 with RS3PE, 13 with RA, 44 with PMR, and 18 with GCA) and 37 controls. Edema occurred in five patients with RS3PE, four with RA, and one with PMR, but not patients with GCA. Serum VEGF levels were significantly higher in individuals with rheumatic diseases (849 (405.5–1235.5) pg/ml) relative to the controls (484 (302–555) pg/ml) (p < 0.001). There were no significant differences between patients with RS3PE, RA, PMR, or GCA in terms of the VEGF serum levels (p = 0.60) or plasma levels (p = 0.57). Similarly, the occurrence of edema did not correlate with VEGF levels. Conclusion VEGF increases in rheumatic diseases compared to a control group. This was not associated with specific rheumatic diseases or with edematous rheumatic diseases.
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Affiliation(s)
- Perrine Smets
- Département de médecine interne, Centre Hospitalier Universitaire Gabriel Montpied, 58, rue Montalembert, 63000, Clermont-Ferrand, France.
| | - Valérie Devauchelle-Pensec
- Département de rhumatologie, Centre Hospitalier Régional et Universitaire de Brest, 2 Avenue Foch, 29200, Brest, France
| | - Paul-Olivier Rouzaire
- Département d'immunologie, Centre Hospitalier Universitaire Gabriel Montpied, 58, rue Montalembert, 63000, Clermont-Ferrand, France
| | - Bruno Pereira
- Département de délégation de recherche clinique, Centre Hospitalier Universitaire Gabriel Montpied, 58, rue Montalembert, 63000, Clermont-Ferrand, France
| | - Marc Andre
- Département de médecine interne, Centre Hospitalier Universitaire Gabriel Montpied, 58, rue Montalembert, 63000, Clermont-Ferrand, France
| | - Martin Soubrier
- Département de rhumatologie, Centre Hospitalier Universitaire Gabriel Montpied, 58, rue Montalembert, 63000, Clermont-Ferrand, France
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14
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Lahaye C, Soubrier M, Mulliez A, Bardin T, Cantagrel A, Combe B, Dougados M, Flipo RM, Le Loët X, Shaeverbeke T, Ravaud P, Mariette X, Gottenberg JE. Effectiveness and safety of abatacept in elderly patients with rheumatoid arthritis enrolled in the French Society of Rheumatology's ORA registry. Rheumatology (Oxford) 2016; 55:874-82. [PMID: 26822072 DOI: 10.1093/rheumatology/kev437] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To study the effect of age on the risk-benefit balance of abatacept in RA. METHODS Data from the French orencia and RA registry, including a 2-year follow-up, were used to compare the effectiveness and safety of abatacept according to age. RESULTS Among the 1017 patients, 103 were very elderly (⩾75 years), 215 elderly (65-74), 406 intermediate aged (50-64) and 293 very young (<50). At baseline, elderly and very elderly patients had longer disease duration, higher CRP levels and higher disease activity. These age groups showed a lower incidence of previous anti-TNF therapy and less common concomitant use of DMARDs, but a similar use of corticosteroid therapy. After adjusting for disease duration, RF/ACPA positivity, use of DMARDs or corticosteroids and previous anti-TNF treatment, the EULAR response (good or moderate) and the remission rate were not significantly different between the four age groups. At 6 months, the very elderly had a significantly lower likelihood of a good response than the very young (odds ratio = 0.15, 95% CI: 0.03, 0.68). The decrease in DAS28-ESR over the 24-month follow-up period did not differ by age. Increasing age was associated with a higher rate of discontinuation for adverse events, especially severe infections (per 100 patient-years: 1.73 in very young, 4.65 in intermediates, 5.90 in elderly, 10.38 in very elderly; P < 0.001). CONCLUSION The effectiveness of abatacept is not affected by age, but the increased rate of side effects, especially infections, in the elderly must be taken into account.
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Affiliation(s)
| | | | - Aurélien Mulliez
- Biostatistics Unit, La Délégation Recherche Clinique et Innovation, CHU de Clermont-Ferrand, Clermont-Ferrand
| | - Thomas Bardin
- Department of Rheumatology, Hôpital Lariboisière, Assistance Publique, Hôpitaux de Paris, Paris
| | | | - Bernard Combe
- Department of Rheumatology, Hôpital Lapeyronie, Montpellier, Université Montpellier I, Montpellier
| | - Maxime Dougados
- Department of Rheumatology, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris INSERM (U1153), Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris
| | | | - Xavier Le Loët
- Department of Rheumatology, Rouen Teaching Hospital, Rouen
| | | | - Philippe Ravaud
- Centre d'Epidémiologie Clinique, Hotel Dieu, Assistance Publique, Hôpitaux de Paris
| | - Xavier Mariette
- Department of Rheumatology, Hôpital Bicêtre, Assistance Publique, Hôpitaux de Paris and
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Lahaye C, Tatar Z, Dubost JJ, Soubrier M. Overview of biologic treatments in the elderly. Joint Bone Spine 2015; 82:154-60. [DOI: 10.1016/j.jbspin.2014.10.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 10/22/2014] [Indexed: 12/25/2022]
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Pers YM, Schaub R, Constant E, Lambert J, Godfrin-Valnet M, Fortunet C, Bourichi W, Prades BP, Wendling D, Gaudin P, Jorgensen C, Maillefert JF, Marotte H. Efficacy and safety of tocilizumab in elderly patients with rheumatoid arthritis. Joint Bone Spine 2015; 82:25-30. [DOI: 10.1016/j.jbspin.2014.07.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 07/31/2014] [Indexed: 12/11/2022]
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