Drs. Genevay and Finckh contributed equally to this study.
Tolerance and effectiveness of anti–tumor necrosis factor α therapies in elderly patients with rheumatoid arthritis: A population-based cohort study
Version of Record online: 30 APR 2007
Copyright © 2007 by the American College of Rheumatology
Arthritis Care & Research
Volume 57, Issue 4, pages 679–685, 15 May 2007
How to Cite
Genevay, S., Finckh, A., Ciurea, A., Chamot, A.-M., Kyburz, D., Gabay, C. and Physicians of the Swiss Clinical Quality Management Program for Rheumatoid Arthritis (2007), Tolerance and effectiveness of anti–tumor necrosis factor α therapies in elderly patients with rheumatoid arthritis: A population-based cohort study. Arthritis & Rheumatism, 57: 679–685. doi: 10.1002/art.22688
- Issue online: 30 APR 2007
- Version of Record online: 30 APR 2007
- Manuscript Accepted: 16 OCT 2006
- Manuscript Received: 22 JUN 2006
- Geneva University
- Zurich University
- Swiss National Fund. Grant Number: 32-105923-1
- Swiss National Science Foundation. Grant Number: 320000-107592
- Rheumatoid arthritis;
- Anti–tumor necrosis factor
Limited data have been published on tolerance to and efficacy of classic or biologic disease-modifying antirheumatic drugs in elderly patients with rheumatoid arthritis (RA). The goal of the present study was to evaluate the tolerance to and effectiveness of anti–tumor necrosis factor (anti-TNF) agents in elderly patients (≥65 years old) with RA (ERA) in comparison with younger patients (YRA).
The Swiss Clinical Quality Management program for RA is a longitudinal population-based cohort. All patients who had received at least 1 dose of anti-TNF agents between January 1997 and November 2005 were included and categorized according to their age. Tolerance was assessed by analyzing discontinuation rates of anti-TNF agents. Effectiveness of these agents was assessed by analyzing RA disease activity (Disease Activity Score in 28 joints [DAS28]) and functional disability (Health Assessment Questionnaire [HAQ]) after anti-TNF initiation.
Among 1,571 patients with RA treated with anti-TNF agents, 344 were ≥65 years of age at treatment initiation. Drug discontinuation rates (median time 3 years) and mean change in DAS28 scores at 2 years (–0.65 versus –0.58) were identical in ERA and YRA. However, HAQ score improved significantly less in ERA (–0.02) than in YRA (–0.1) and a subsequent analysis revealed that this finding was essentially due to patients >75 years of age.
Age in itself should not interfere with the decision to treat elderly patients with RA with anti-TNF agents. In a subset of patients ages >75 years, no functional improvement according to HAQ should be expected despite improvements in disease activity.