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Keywords:

  • Rheumatoid arthritis;
  • Elderly;
  • Anti–tumor necrosis factor

Abstract

Objective

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).

Methods

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.

Results

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.

Conclusion

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.