Differential long-term retention of biological disease-modifying antirheumatic drugs in patients with rheumatoid arthritis by age group from the FIRST registry

Akio Kawabe,Takeshi Asakawa,Yoshiya Tanaka,Kazuhisa Nakano,Satoshi Kubo

doi:10.1186/s13075-020-02233-9

Akio Kawabe, Takeshi Asakawa + Show 3 more

Open Access

https://doi.org/10.1186/s13075-020-02233-9

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Abstract

BackgroundThe effectiveness and safety of biological disease-modifying antirheumatic drugs (bDMARDs) by age group (< 65, 65–74, and ≥ 75 years) are uncertain. We examined retention rates reflecting the effectiveness and safety of bDMARDs in actual clinical practice for clarifying optimal therapeutic strategies for rheumatoid arthritis (RA) by age groups.MethodsData of patients who were treated with tumor necrosis factor inhibitors (TNFi), abatacept (ABA), and tocilizumab (TCZ) between February 2011 and April 2017 were collected from a prospective observational registry of RA patients. A total of 1362 patients were enrolled, of which 695 were aged < 65 years, 402 were aged 65–74 years, and 265 were aged ≥ 75 years. Primary outcome was the drug retention rate in adjusted data using inverse probability of treatment weighting based on generalized propensity scores.ResultsIn patients aged < 65 years, 3-year retention rates of TNFi, ABA, and TCZ were 43%, 47%, and 69%, respectively (ABA versus TCZ, p = 0.017; TNFi versus TCZ, p = 0.002). In patients aged 65–74 years, 3-year retention rates of TNFi, ABA, and TCZ were 44%, 53%, and 60%, respectively (TCZ versus TNFi, p = 0.034). In patients aged ≥ 75 years, 3-year retention rates for TNFi, ABA, and TCZ were 38%, 63%, and 58%, respectively (ABA versus TNFi, p = 0.017).ConclusionsWe found that the effectiveness and safety of TCZ were maximal in patients aged < 75 years and that patients aged ≥ 75 years might be suitable candidates for TCZ and ABA therapy. The use of therapeutic strategies appropriate to each age group might improve the outcomes of bDMARD therapy for RA.

Highlights

The effectiveness and safety of biological disease-modifying antirheumatic drugs by age group (< 65, 65–74, and ≥ 75 years) are uncertain
Registration was initiated in March 2003; in total, 3891 patients with rheumatoid arthritis (RA) were registered until March 2020. biological disease-modifying antirheumatic drugs (bDMARDs) included tumor necrosis factor inhibitors (TNFi), abatacept (ABA), and tocilizumab (TCZ)
Patients aged ≥ 75 years exhibited a higher incidence of advanced-stage RA, higher ABA and GC usage, higher pre-existing lung disease prevalence, lower MTX usage, stronger inflammatory responses (e.g., C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)), higher rheumatoid factor (RF) levels, higher clinical disease activity index (CDAI)

Summary

Introduction

The effectiveness and safety of biological disease-modifying antirheumatic drugs (bDMARDs) by age group (< 65, 65–74, and ≥ 75 years) are uncertain. A new definition of true elderly people as those aged ≥ 75 years has been proposed [2] In such a super-aged society, patients with RA are increasingly becoming older. For RA, methotrexate (MTX) and biological diseasemodifying antirheumatic drugs (bDMARDs) are key options for achieving treat-to-target goals [3]. This stands true for treating elderly RA patients. The effectiveness and safety of bDMARDs should be compared and analyzed across age groups

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