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Kubo S, Miyazaki Y, Todoroki Y, Nagayasu A, Kanda R, Aritomi T, Matsunaga S, Ueno M, Miyagawa I, Sonomoto K, Hanami K, Nakayamada S, Tanaka Y. Generation-Dependent Retention Rates and Reasons for Discontinuation of Molecular Targeted Therapies in Patients with Rheumatoid Arthritis: From FIRST Registry. Rheumatol Ther 2023; 10:1705-1723. [PMID: 37856034 PMCID: PMC10654306 DOI: 10.1007/s40744-023-00603-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 09/22/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION The study aimed to optimize medical care for elderly patients with rheumatoid arthritis (RA) by examining the 3-year continuation rate of different molecular targeted therapies across age groups in Japan, which has a significant elderly population. METHODS The study included patients with RA who started molecular targeted therapies between 2013 and 2019 and divided them into three age groups. The primary outcome was to assess the 3-year continuation rate of each drug and analyze reasons for treatment discontinuation using inverse probability of treatment weighting. RESULTS Among 2292 patients analyzed, tumor necrosis factor (TNF) inhibitors were most commonly used in those younger than 65 years of age (43.5%), while Janus kinase (JAK) inhibitors were also utilized (17.1%). In contrast, JAK inhibitors were less frequently used in patients aged 75 years and older (7.8%), with cytotoxic T lymphocyte antigen 4 immunoglobulin fusion proteins (CTLA4-Ig) being the most common (39.2%). JAK inhibitors and anti-interleukin-6 receptor (IL-6R) antibodies had higher continuation rates than other drugs in patients under 65 years (p < 0.001). For those aged 65-74 years, JAK inhibitors and CTLA4-Ig had higher continuation rates (p < 0.001), while among those aged 75 years and older, CTLA4-Ig and IL-6R antibodies had higher continuation rates (p < 0.001). Inadequate efficacy was the main reason for discontinuation in all age groups, while infection leading to discontinuation increased with age. CONCLUSIONS The study highlights the need to consider different age groups separately in elderly RA care. Among patients aged 75 years and older, abatacept and anti-IL-6R antibodies showed the highest continuation rates, suggesting their potential suitability and efficacy for this specific age cohort.
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Affiliation(s)
- Satoshi Kubo
- Department of Molecular Targeted Therapies, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Yusuke Miyazaki
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Yasuyuki Todoroki
- Department of Molecular Targeted Therapies, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Atsushi Nagayasu
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Ryuichiro Kanda
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Takafumi Aritomi
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Satsuki Matsunaga
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Masanobu Ueno
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Ippei Miyagawa
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Koshiro Sonomoto
- Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Kentaro Hanami
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Shingo Nakayamada
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.
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Temmoku J, Migita K, Yoshida S, Matsumoto H, Fujita Y, Matsuoka N, Yashiro-Furuya M, Asano T, Sato S, Suzuki E, Watanabe H, Miyata M. Real-world comparative effectiveness of bDMARDs and JAK inhibitors in elderly patients with rheumatoid arthritis. Medicine (Baltimore) 2022; 101:e31161. [PMID: 36281115 PMCID: PMC9592439 DOI: 10.1097/md.0000000000031161] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In this retrospective cohort study, we compared the retention rates and effectiveness of biologic disease modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs (targeted disease modifying antirheumatic drug [tsDMARDs]: Janus kinase inhibitors [JAKi]) in elderly patients with RA. One hundred thirty-four elderly RA patients (≥65 years) who were initiated with bDMARDs (n = 80) or JAKi (n = 54) between 2016 and 2020 in our institute were enrolled in this analysis. Follow-up was conducted at 4-week intervals from the start of bDMARDs or JAKi. We compared the drug retention and clinical response at 24 week between elderly RA patients treated with bDMARDs and JAKi. In the demographic data, more disease duration, the proportion of previous bDMARDs use and less the proportion of glucocorticoid use in JAKi group was significantly observed compared to the bDMARDs group. Otherwise, there was no significant difference in the other variables between the bDMARDs and JAKi groups. In the JAKi group, drug retention rate was not significantly different compared to the bDMARDs group (HR: 0.723, 95% CI: 0.406-1.289, P = .266). Also, there was no significant difference in the proportion of patients achieving good or moderate European alliance of associations for rheumatology (EULAR) response at 24 week between these two groups (bDMARDs; 88.6% vs JAKi; 91.8%, P = .158). In elderly RA patients initiated with bDMARDs or JAKi, drug retention rates of these targeted therapies did not differ significantly between these two groups. These findings suggest that elderly RA patients can achieve similar clinical improvement after initiating bDMARDs or JAKi.
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Affiliation(s)
- Jumpei Temmoku
- Department of Rheumatology, Japanese Red Cross Fukushima Hospital, Yashima, Fukushima, Japan
- Department of Rheumatology, Fukushima Medical University School of Medicine, Hikarigaoka, Fukushima, Fukushima, Japan
| | - Kiyoshi Migita
- Department of Rheumatology, Fukushima Medical University School of Medicine, Hikarigaoka, Fukushima, Fukushima, Japan
- *Correspondence: Kiyoshi Migita, Department of Rheumatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan (e-mail: )
| | - Shuhei Yoshida
- Department of Rheumatology, Fukushima Medical University School of Medicine, Hikarigaoka, Fukushima, Fukushima, Japan
| | - Haruki Matsumoto
- Department of Rheumatology, Fukushima Medical University School of Medicine, Hikarigaoka, Fukushima, Fukushima, Japan
| | - Yuya Fujita
- Department of Rheumatology, Fukushima Medical University School of Medicine, Hikarigaoka, Fukushima, Fukushima, Japan
| | - Naoki Matsuoka
- Department of Rheumatology, Fukushima Medical University School of Medicine, Hikarigaoka, Fukushima, Fukushima, Japan
| | - Makiko Yashiro-Furuya
- Department of Rheumatology, Fukushima Medical University School of Medicine, Hikarigaoka, Fukushima, Fukushima, Japan
| | - Tomoyuki Asano
- Department of Rheumatology, Fukushima Medical University School of Medicine, Hikarigaoka, Fukushima, Fukushima, Japan
| | - Shuzo Sato
- Department of Rheumatology, Fukushima Medical University School of Medicine, Hikarigaoka, Fukushima, Fukushima, Japan
| | - Eiji Suzuki
- Department of Rheumatology, Fukushima Medical University School of Medicine, Hikarigaoka, Fukushima, Fukushima, Japan
| | - Hiroshi Watanabe
- Department of Rheumatology, Fukushima Medical University School of Medicine, Hikarigaoka, Fukushima, Fukushima, Japan
| | - Masayuki Miyata
- Department of Rheumatology, Japanese Red Cross Fukushima Hospital, Yashima, Fukushima, 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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Freitas R, Godinho F, Madeira N, Fernandes BM, Costa F, Santiago M, Neto A, Azevedo S, Couto M, Sequeira G, Dias JM, Bernardes M, Miranda L, Pereira JP, Fonseca JE, Santos MJ. Safety and Effectiveness of Biologic Disease-Modifying Antirheumatic Drugs in Older Patients with Rheumatoid Arthritis: A Prospective Cohort Study. Drugs Aging 2020; 37:899-907. [PMID: 33205322 DOI: 10.1007/s40266-020-00801-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVE The number of older patients with rheumatoid arthritis is increasing, but data on drug effectiveness and safety in these patients are scarce. This study assessed the effectiveness and safety of biologic disease-modifying antirheumatic drugs in older patients with rheumatoid arthritis. METHODS This prospective cohort study was based on data recorded in the Rheumatic Diseases Portuguese Register (Reuma.pt). Treatment persistence, European League Against Rheumatism response at 6 and 12 months, and adverse events were compared between adult (age < 65 years), old (age 65-74 years), and very old (age ≥ 75 years) patients. RESULTS In total, 2401 patients were included, of which 379 were old and 83 were very old. Older patients had higher disease activity at baseline (Disease Activity Score 28: 5.5 in adults, 5.7 in old patients, and 6 in very old patients; p = 0.02) and more comorbidities, with patients aged 65-74 years beginning biologic disease-modifying antirheumatic drugs later in the course of rheumatoid arthritis. Treatment persistence was similar in the three patient groups (p = 0.07). The European League Against Rheumatism response rates were comparable in the three groups at 6 months (81.6% of adults, 75.2% of old patients, and 81.8% of very old patients; p = 0.19), and inferior in old patients at 12 months. The proportion of patients who experienced adverse events was also similar in the three groups (21% of adults, 22.5% of old patients, and 22.9% of very old patients; p = 0.76), but the rate of serious adverse events was higher in old patients (1.94/100 patient-years) and very old patients (4.29/100 patient-years) compared with 1.03/100 patient-years in adult patients with rheumatoid arthritis (p < 0.05). CONCLUSIONS Adults, old patients, and very old patients with rheumatoid arthritis benefit similarly from biologic disease-modifying antirheumatic drug treatments, although older patients have more active disease at baseline and more comorbidities. However, it is necessary to consider the risk of serious adverse events in older patients when prescribing a biologic.
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Affiliation(s)
- Raquel Freitas
- Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal.
| | - Fátima Godinho
- Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal
| | | | | | - Flávio Costa
- Rheumatology Department, Centro Hospitalar e Universitário Coimbra, Coimbra, Portugal
| | - Mariana Santiago
- Rheumatology Department, Centro Hospitalar e Universitário Coimbra, Coimbra, Portugal
| | - Agna Neto
- Rheumatology Department, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | | | - Maura Couto
- Rheumatology Department, Hospital São Teotónio, Viseu, Portugal
| | | | - João Madruga Dias
- Rheumatology Department, Centro Hospitalar Médio Tejo, Torres Novas, Portugal.,Nova Medical School, Lisboa, Portugal
| | - Miguel Bernardes
- Rheumatology Department, Centro Hospitalar e Universitário São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Luís Miranda
- Instituto Português Reumatologia, Lisboa, Portugal
| | - Joaquim Polido Pereira
- Rheumatology Department, Centro Hospitalar e Universitário Santa Maria, Lisboa, Portugal.,Instituto de Medicina Molecular, Lisboa, Portugal.,Faculty of Medicine, University of Lisboa, Lisboa, Portugal
| | - João Eurico Fonseca
- Rheumatology Department, Centro Hospitalar e Universitário Santa Maria, Lisboa, Portugal.,Instituto de Medicina Molecular, Lisboa, Portugal.,Faculty of Medicine, University of Lisboa, Lisboa, Portugal
| | - Maria José Santos
- Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal.,Faculty of Medicine, University of Lisboa, Lisboa, Portugal
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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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Fleischmann R, Alam J, Arora V, Bradley J, Schlichting DE, Muram D, Smolen JS. Safety and efficacy of baricitinib in elderly patients with rheumatoid arthritis. RMD Open 2017; 3:e000546. [PMID: 29071120 PMCID: PMC5640108 DOI: 10.1136/rmdopen-2017-000546] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/05/2017] [Accepted: 09/15/2017] [Indexed: 12/27/2022] Open
Affiliation(s)
- Roy Fleischmann
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Vipin Arora
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - John Bradley
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | - David Muram
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
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Abstract
Mainly due to the general demographic changes and decreasing mortality in rheumatic diseases based on therapeutic progress, the proportion of older patients treated by rheumatologists is growing. Drug treatment in the elderly, however, harbors certain risks including age-specific pharmacokinetic features and high rates of multimorbidity and polypharmacy resulting in a risk of drug interactions and adherence problems. Nevertheless, older patients suffering from rheumatic diseases ought to be treated with the same intensity and same targets as the younger counterparts. Bearing all these facts in mind it is a balancing act for rheumatologists to find an optimal treatment for the individual elderly patient. Fear of risks should not lead to hesitant use of drugs leaving these patients alone with treatment deficits, as some studies have suggested.
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Affiliation(s)
- K Krüger
- Rheumatologisches Praxiszentrum, St. Bonifatius Str. 5, 81541, München, Deutschland.
| | - A Strangfeld
- Deutsches Rheuma-Forschungszentrum (DRFZ), Berlin, Deutschland
| | - C Kneitz
- Klinik für Innere Medizin II, Rheumatologie/Immunologie, Rheumazentrum, Klinikum Südstadt Rostock, Rostock, Deutschland
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8
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Affiliation(s)
- Tsuyoshi TAKEDA
- Department of Internal Medicine, Japan Organization of Occupational Health and Safety, Hokkaido Spinal Cord Injury Center
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9
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Biologics Prescribing for Rheumatoid Arthritis in Older Patients: A Single-Center Retrospective Cross-Sectional Study. Rheumatol Ther 2015; 2:165-172. [PMID: 27747537 PMCID: PMC4883268 DOI: 10.1007/s40744-015-0021-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Indexed: 12/25/2022] Open
Abstract
Introduction Appropriate medical treatment can reduce the morbidity and mortality associated with rheumatoid arthritis (RA). Studies have shown that older patients with RA may be treated less aggressively than their younger counterparts, despite evidence suggesting that biologic treatments may be safe and efficacious in older age groups. The aim of this study was to assess whether patient age was associated with biologic treatment for RA in a single center in the United Kingdom. Methods This was a retrospective cross-sectional analysis of clinic records for all patients with RA reviewed over 1 year in our center. Data were also collected on healthcare use in patients aged 65 years and older as a surrogate marker of comorbidity. Results In total, 856 patients with RA were identified, of which 22.8% were on biologic treatment. Patients on biologics were younger (mean age 58.9 years) compared to the mean age of all patients (61.4 years). Of patients aged less than 65 years, 27.2% were receiving biologic treatment, while only 15.2% of patients aged 65 years or older were on biologics. Increasing age was significantly associated with a lower likelihood of receiving biologic treatment. However, in patients 65 years or older, there was no significant difference in overall healthcare use between those on biologic treatment and those not. Patients treated with prednisolone were found to have a greater number of admissions. Conclusion In our center, older patients are less likely to receive biologic treatment than younger patients. Among older patients we found no difference in healthcare use between those treated with biologics and those not, suggesting similar levels of comorbidity. Potential contributors are discussed, but further assessment is required to determine the reasons for this observation. Electronic supplementary material The online version of this article (doi:10.1007/s40744-015-0021-z) contains supplementary material, which is available to authorized users.
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10
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Diagnosis and Management of Late-Onset Spondyloarthritis: Implications of Treat-to-Target Recommendations. Drugs Aging 2015; 32:515-24. [DOI: 10.1007/s40266-015-0280-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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11
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Abstract
The term "autoimmunity" refers to a pathological condition in which the immunological tolerance of self-antigens is broken through, cross-reactive T cells are activated, and autoantibodies are produced by B cells. The intricate interplay among those aberrantly activated immune cells as well as inflammatory cytokines secreted by them contributes to the development of proinflammatory cascade which eventually leads to the occurrence of autoimmune diseases (AIDs) and organ damage. Autoimmune diseases occupy a broad spectrum of human diseases with more than 70 different disorders and afflict approximately 5-8 % of the world's population. AIDs can be categorized into organ-specific and systemic. Although the exact mechanism of AIDs remains elusive, it is generally believed that both genetic polymorphism and environmental exposure are involved in the development of AIDs. Aberrant epigenetic marks are also identified in patients with AIDs. In addition, dysregulation of innate immune system and molecular mimicry are indicated to play important roles in the initiation and maintenance of autoreactive inflammation. Based on the progress made in elucidating molecular mechanisms underlying AIDs, novel biomarkers for prediction, early diagnosis, prognosis and treatment response, and therapeutic strategies are proposed, which represents a promising future in the battle against AIDs. However, challenges remain regarding the clinical application of these potential new tools.
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Affiliation(s)
- Qianjin Lu
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenetics, Second Xiangya Hospital, Central South University, #139 Renmin Middle Rd, Changsha, Hunan, 410011, People's Republic of China,
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12
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Goodman SM. Optimizing Perioperative Outcomes for Older Patients with Rheumatoid Arthritis Undergoing Arthroplasty: Emphasis on Medication Management. Drugs Aging 2015; 32:361-9. [DOI: 10.1007/s40266-015-0262-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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13
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Gutiérrez WA, Samudio Brigard ML, Fernández-Ávila DG, Díaz MC, Gutiérrez Dávila JM. Artritis reumatoide en el anciano. Revisión narrativa. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/s0121-8123(13)70003-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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14
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Reichling DB, Green PG, Levine JD. The fundamental unit of pain is the cell. Pain 2013; 154 Suppl 1:S2-9. [PMID: 23711480 DOI: 10.1016/j.pain.2013.05.037] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 04/12/2013] [Accepted: 05/20/2013] [Indexed: 12/22/2022]
Abstract
The molecular/genetic era has seen the discovery of a staggering number of molecules implicated in pain mechanisms [18,35,61,69,96,133,150,202,224]. This has stimulated pharmaceutical and biotechnology companies to invest billions of dollars to develop drugs that enhance or inhibit the function of many these molecules. Unfortunately this effort has provided a remarkably small return on this investment. Inevitably, transformative progress in this field will require a better understanding of the functional links among the ever-growing ranks of "pain molecules," as well as their links with an even larger number of molecules with which they interact. Importantly, all of these molecules exist side-by-side, within a functional unit, the cell, and its adjacent matrix of extracellular molecules. To paraphrase a recent editorial in Science magazine [223], although we live in the Golden age of Genetics, the fundamental unit of biology is still arguably the cell, and the cell is the critical structural and functional setting in which the function of pain-related molecules must be understood. This review summarizes our current understanding of the nociceptor as a cell-biological unit that responds to a variety of extracellular inputs with a complex and highly organized interaction of signaling molecules. We also discuss the insights that this approach is providing into peripheral mechanisms of chronic pain and sex dependence in pain.
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Affiliation(s)
- David B Reichling
- Department of Medicine, Division of Neuroscience, University of California-San Francisco, San Francisco, CA, USA; Department of Oral and Maxillofacial Surgery, Division of Neuroscience, University of California-San Francisco, San Francisco, CA, USA
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15
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Harrold LR, Peterson D, Beard AJ, Gurwitz JH, Briesacher BA. Time trends in medication use and expenditures in older patients with rheumatoid arthritis. Am J Med 2012; 125:937.e9-15. [PMID: 22682794 PMCID: PMC3432666 DOI: 10.1016/j.amjmed.2011.11.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 11/18/2011] [Accepted: 11/27/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND We sought to examine how expansions in insurance coverage of nonbiologic and biologic disease-modifying antirheumatic drugs affected the access, costs, and health status of older patients with rheumatoid arthritis. METHODS We identified a nationally representative sample of older adults with rheumatoid arthritis in the 2000-2006 Medicare Current Beneficiary Survey (unweighted n=1051). We examined changes in disease-modifying antirheumatic drug use, self-reported health status, functional status (activities of daily living), and total costs and out-of-pocket costs for medical care and prescription drugs. Tests for time trends were conducted using weighted regressions. RESULTS Between 2000 and 2006, the proportion of older adults with rheumatoid arthritis who received biologics tripled (4.6% vs 13.2%, P=.01), whereas the proportion of people who used a nonbiologic did not change. During the same period, the proportion of older patients with rheumatoid arthritis rating their health as excellent/good significantly increased (43.0% in 2000 to 55.6% in 2006; P=.015). Significant improvements occurred in activities of daily living measures of functional status. Total prescription drug costs (in 2006 US dollars) increased from $2645 in 2000 to $4685 in 2006, P=.0001, whereas out-of-pocket prescription costs remained constant ($842 in 2000 vs $832 in 2006; P=.68). Total medical costs did not significantly increase ($16,563 in 2000 vs $19,510 in 2006; P=.07). CONCLUSION Receipt of biologics in older adults with rheumatoid arthritis increased over a period of time when insurance coverage was expanded without increasing patients' out-of-pocket costs. During this time period, concurrent improvements in self-reported health status and functional status suggest improved arthritis care.
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Vukmanovic-Stejic M, Rustin MHA, Nikolich-Zugich J, Akbar AN. Immune responses in the skin in old age. Curr Opin Immunol 2011; 23:525-31. [PMID: 21703840 DOI: 10.1016/j.coi.2011.05.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 05/25/2011] [Accepted: 05/26/2011] [Indexed: 01/05/2023]
Abstract
A marked increase in the susceptibility to cutaneous infections and malignancies has been observed in older humans indicating that cutaneous immunity becomes defective with age. In this review we will focus on recent developments in the understanding of age-related changes in immune function of the skin with a particular emphasis on how alterations in the interaction between cells involved in innate and adaptive immunity leads to decreased cutaneous antigen-specific T cell immunosurveillance.
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Affiliation(s)
- Milica Vukmanovic-Stejic
- Division of Infection and Immunity, Department of Immunology, University College London, London W1T 4JF, United Kingdom
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Verstappen SMM, Lunt M, Bunn DK, Scott DGI, Symmons DPM. In patients with early inflammatory polyarthritis, ACPA positivity, younger age and inefficacy of the first non-biological DMARD are predictors for receiving biological therapy: results from the Norfolk Arthritis Register. Ann Rheum Dis 2011; 70:1428-32. [PMID: 21551505 PMCID: PMC3128326 DOI: 10.1136/ard.2010.148106] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objectives To identify baseline disease-related predictors in patients with early inflammatory polyarthritis (IP) for starting subsequent biological therapy and to determine if patients who failed their first non-biological disease-modifying antirheumatic drug (DMARD) within 6 months were more likely to need biological therapy. Methods Patients with early IP recruited between 1990 and 1994 (cohort 1) and between 2000 and 2004 (cohort 2) in the Norfolk Arthritis Register were included in this study. The association between possible predictors with the start of biological therapy was assessed using Cox proportional hazards regression models. Results 32/407 (7.9%) patients in cohort 1 and 45/416 (10.8%) patients in cohort 2 received biological therapy during follow-up. In both cohorts, anti-citrullinated protein antibody (ACPA) positivity (cohort 1, HR 7.62, 95% CI 2.46 to 23.58; cohort 2, HR 4.68, 95% CI 2.23 to 9.78) was the strongest predictor for starting biological therapy. In cohort 2, younger patients (HR 0.97, 95% CI 0.95 to 0.99) and patients who failed their first non-biological DMARD within 6 months due to inefficacy were also more likely to receive biological therapy (HR 2.35, 95% CI 1.05 to 5.27). Conclusion Patients with early IP who are ACPA positive, are younger or who fail their first non-biological DMARD due to inefficacy within 6 months are more likely to need biological therapy.
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Affiliation(s)
- Suzanne M M Verstappen
- Arthritis Research UK Epidemiology Unit, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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Hmamouchi I, Bahiri R, Hajjaj-Hassouni N. Clinical and radiological presentations of late-onset spondyloarthritis. ISRN RHEUMATOLOGY 2011; 2011:840475. [PMID: 23509636 PMCID: PMC3595659 DOI: 10.5402/2011/840475] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 01/23/2011] [Indexed: 12/31/2022]
Abstract
The last few years have witnessed considerable progress in the diagnosis and treatment of spondyloarthritis (SpA). Tools are now available for establishing the diagnosis at an early stage, when appropriate treatment may be able to control the inflammatory process, limit the functional impairments, and improve quality of life. Late-onset SpA after the age of 50 years is uncommon. All the spondyloarthritis subgroups are represented in the elderly. Thus, late onset spondyloarthritis is underdiagnosed in favour of other inflammatory disorders that are more frequently observed in the elderly because the clinical or radiological presentations of late-onset spondyloarthritis are modified in the elderly. They deserve further attention because age population is increasing and new criteria for axial SpA including sacroiliitis detected by MRI may help the clinician with diagnosis. Specific studies evaluating the benefit/risk ratio of TNFα-blocking agents in late onset SpA patients are required.
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Affiliation(s)
- Ihsane Hmamouchi
- Laboratory of Information and Research on Bone Diseases (LIRPOS), Department of Rheumatology, Faculty of Medicine and Pharmacy, El Ayachi Hospital, University Hospital of Rabat-Sale, University Mohammed V Souissi, Morocco ; Laboratory of Biostatistical, Clinical and Epidemiological Research (LBRCE), Faculty of Medicine and Pharmacy, University Mohammed V Souissi, Rabat, Morocco
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&NA;. Tumour necrosis factor-α inhibitors have a growing role in managing late-onset ankylosing spondylitis and spondylarthritis. DRUGS & THERAPY PERSPECTIVES 2011. [DOI: 10.2165/11206480-000000000-00000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Yang EJ, Moon JY, Kim MJ, Kim DS, Kim CS, Lee WJ, Lee NH, Hyun CG. Inhibitory effect of Jeju endemic seaweeds on the production of pro-inflammatory mediators in mouse macrophage cell line RAW 264.7. J Zhejiang Univ Sci B 2010; 11:315-22. [PMID: 20443209 DOI: 10.1631/jzus.b0900364] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Seaweed has been used in traditional cosmetics and as a herbal medicine in treatments for cough, boils, goiters, stomach ailments, and urinary diseases, and for reducing the incidence of tumors, ulcers, and headaches. Despite the fact that seaweeds are frequently used in the practice of human health, little is known about the role of seaweed in the context of inflammation. This study aimed to investigate the influence of Jeju endemic seaweed on a mouse macrophage cell line (RAW 264.7) under the stimulation of lipopolysaccharide (LPS). Ethyl acetate extracts obtained from 14 different kinds of Jeju seaweeds were screened for inhibitory effects on pro-inflammatory mediators. Our results revealed that extracts from five seaweeds, Laurencia okamurae, Grateloupia elliptica, Sargassum thunbergii, Gloiopeltis furcata, and Hizikia fusiformis, were potent inhibitors of the production of pro-inflammatory mediators such as nitric oxide (NO), prostaglandin E(2) (PGE(2)), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha). Based on these results, the anti-inflammatory effects and low cell toxicity of these seaweed extracts suggest potential therapeutic applications in the regulation of the inflammatory response.
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Affiliation(s)
- Eun-Jin Yang
- Jeju Biodiversity Research Institute, Jeju High-Tech Development Institute, Jeju 699-943, Korea
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