Abstract
Background and Objectives: Treatment for elderly (aged ≥75 years) patients with rheumatoid arthritis (RA) is important because they usually have several complications and organ dysfunction and are more susceptible to drug-related adverse events. Abatacept (ABT) treatment is relatively safe in elderly RA patients; however, the real-world data of efficacy and long-term retention of ABT is sparse in such patients. This study aimed to investigate the clinical efficacy and long-term retention rates of ABT in elderly Japanese RA patients. Materials and Methods: This 10-year retrospective observational cohort study was performed in two centers in Fukushima, Japan. We reviewed the clinical features of elderly RA patients who received ABT and investigated the differences in retention rates with concomitant administration of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). Results: The clinical characteristics of younger (<75 years old, 39 cases) and elderly (≥75 years old, 20 cases) RA patients were generally similar. Although the efficacy was also similar, the concomitant administration of csDMARDs with ABT differed between the two groups. Younger patients significantly decreased methotrexate (MTX) administration than elderly patients (p < 0.01), and elderly patients significantly received tacrolimus (TAC) (p < 0.01) or salazosulfapyridine (SASP; p = 0.01) than younger patients. The overall retention and infection-free survival rates were similar between the two groups. Conclusion: Elderly RA patients showed sustained retention rates compared to younger RA patients. TAC and SASP can help to maintain sustained retention rates in elderly RA patients.
Highlights
The population of elderly patients with rheumatoid arthritis (RA) is increasing [1], and treatment, especially of those aged ≥75 years, is a critical issue because these patients may have complications and organ dysfunction and be more susceptive to adverse drug events [2,3,4]
Among RA patients treated with ABT, 93.2% (55/59) were positive for rheumatoid factor (RF) and/or anti-cyclic citrullinated peptide (CCP) antibodies (Table 1)
The differences in the choice of csDMARDs between the two patient groups were attributed to the following factors: ABT treatment alone can be sufficient without MTX combination [10,11], the risk of severe infection in elderly patients receiving ABT is relatively low [5], and, importantly, adverse events are a concern in elderly RA patients treated with MTX
Summary
The population of elderly patients with rheumatoid arthritis (RA) is increasing [1], and treatment, especially of those aged ≥75 years, is a critical issue because these patients may have complications and organ dysfunction and be more susceptive to adverse drug events [2,3,4]. Data on the long-term retention and efficacy of ABT in elderly RA patients, especially those aged ≥75 years, are sparse. This study investigated the clinical efficacy and retention rates of combinations of ABT and csDMARDs in younger and elderly RA patients over the past 10 years. We attempted to elucidate the desirable choice of csDMARDs in combination with ABT and whether these agents could help to sustain high retention rates in daily clinical practice, even in elderly RA patients. This study aimed to investigate the clinical efficacy and long-term retention rates of ABT in elderly Japanese RA patients. We reviewed the clinical features of elderly RA patients who received ABT and investigated the differences in retention rates with concomitant administration of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). TAC and SASP can help to maintain sustained retention rates in elderly RA patients
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