Biologics show similar activity in patients with elderly-onset RA

A Japanese study showed no difference in efficacy and tolerability of biologics in two different age groups [1].

“Patients with elderly-onset rheumatoid arthritis (RA) could present with higher disease activity and increased disability as compared with those with young-onset RA. Despite this, previous studies showed elderly patients receive biologics less frequently than younger individuals, suggesting patients with elderly-onset RA are potentially undertreated,” said Dr Sadao Jinno (Kobe University School of Medicine, Japan), the study’s lead author. “On the other hand, in daily practice, many elderly-onset RA patients benefit from treatment with biologics. With our study we wanted to investigate if there are differences in efficacy and safety of biologics between the 2 age groups,” said Dr Jinno.

A total of 7,183 patients with RA, aged ≥18, who were enrolled in a Japanese multicentre observational registry between September 2009 and December 2017 took part in the study. The patients had to have a Disease Activity Score 28 (DAS28) ≥3.2 and erythrocyte sedimentation rate (ESR) measurement when they started biologics. Elderly-onset RA was defined as disease onset at ≥60 years. Dr Jinno and his team assessed the relationship between the age of RA onset and the clinical effectiveness of therapy at 48 weeks. The primary outcome for the study was a Clinical Disease Activity Index (CDAI) score at 48 weeks. Secondary outcomes included biologic retention at 48 weeks, achievement of a clinical disease activity index (CDAI) remission, and low disease activity or remission.

There were fewer patients on biologics in the elderly-onset RA group compared with those in the young-onset RA group (18.3% vs 28.0%, P<0.001). Of 989 patients who initiated biologics, 364 (37%) had elderly-onset RA. After adjusting for differences in baseline characteristics between the 2 age groups, researchers found no significant differences in the CDAI scores at 48 weeks. There was a slight trend towards lower CDAI remission rates in the elderly-onset group, but low disease activity/remission rates were similar between the 2 groups. “Our findings showed there were no significant differences in CDAI scores at 48 weeks between elderly-onset and young-onset RA, suggesting biologics can be used for those with elderly-onset RA as effectively as for those with young-onset RA. We also found there was no difference of adverse event discontinuation rates between the 2 groups,” concluded Dr Jinno. Further research in patients older than 75 years is needed to further address this issue of biological therapy in older RA patients.

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   1. Jinno S et al. Abstract 1345. ACR 2019, 9-13 November, Atlanta (GA/USA).

Posted on 4 February 202012 March 2021