Patients with rheumatoid arthritis (RA) whose disease onset occurred at an older age and patients whose disease occurred earlier in life had similar improvements in clinical disease at 48 weeks after initiating biological disease-modifying antirheumatic drugs, according to a poster presented at the American College of Rheumatology/Association of Rheumatology Professionals Annual Meeting.1

Drug maintenance and adverse event discontinuation rates were similar at 48 weeks, as well.

According to the Arthritis Foundation, RA is the most common type of autoimmune arthritis and it is a chronic disease that causes joint pain, stiffness, swelling and decreased movement of the joints. RA most commonly affects the joints of the hands, feet, wrists, elbows, knees, and ankles.2

According to lead study author Sadao Jinno, MD, MSc, instructor of rheumatology at Kobe University School of Medicine, patients with elderly-onset RA could present with higher disease activities and increased disabilities 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 potently undertreated.2

"On the other hand, in our daily practice, we have seen many elderly-onset RA patients treated with biologics effectively and safely. We wanted to investigate if there are differences in efficacy and safety of biologics between the two age groups,” Dr Jinno, said in a statement.2

Researchers in Japan conducted a study with 7183 patients with RA over the age of 18 who were enrolled in a Japanese multicenter observational registry between September 2009 and December 2017. The patients also had to have 3.2 or higher on the Disease Activity Score in 28 joints (DAS-28) and erythrocyte sedimentation rate measurement when they started biologics.1

The researchers assessed the relationships 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 of 48 weeks, while the secondary outcomes included biologic retention at 48 weeks, achievement of a clinical disease activity index remission and low disease activity, or remission.1

Among the patients on biologics, there were less in the elderly-onset RA group compared to the young-onset RA group. Of 989 patients who initiated biologics, 364 (37%) were elderly onset. After adjusting for differences in baseline characteristics between the 2 age groups, researchers found no significant differences in the CDAI scores at 48 weeks. Researchers found a trend toward lower index remission rates in the elderly-onset group, but low disease activity/remission rates were similar between the 2 groups.1

"Our findings showed there were no significant differences in Clinical Disease Activity Index 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 two groups," Dr. Jinno said.2 "Clinicians should choose wisely which patients with elderly-onset RA are safely treated with biologics given that they are still at risk of developing adverse events, especially infections. Next, we plan to investigate if patients with elderly-onset RA respond differently to various modes of biologics."

Reference
  1. Jinno S, Onishi A, Akashi K, Hashimoto M, et al. Are There Differences in Efficacy and Safety of Biological Disease-modifying Antirheumatic Drugs Between Elderly-onset and Young-onset Rheumatoid Arthritis? [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/are-there-differences-in-efficacy-and-safety-of-biological-disease-modifying-antirheumatic-drugs-between-elderly-onset-and-young-onset-rheumatoid-arthritis/.  Accessed November 12, 2019.
  2. What is Rheumatoid Arthritis? Arthritis Foundation website. https://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/what-is-rheumatoid-arthritis.php.  Accessed November 12, 2019.
  3. Biologics Offer Similar Disease Activity Improvement for Both Elderly-Onset and Young-Onset RA Patients [news release]. American College of Rheumatology’s website. https://www.rheumatology.org/About-Us/Newsroom/Press-Releases/ID/1055. Accessed November 22, 2019.