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BMC Musculoskeletal Disorders

, 17:333

Clinical rheumatology and osteoporosis

Abstract

BackgroundThe concerns about the development of adverse events AEs in elderly RA patients as a result of age-related changes in drug metabolism and the presence of comorbid illnesses are emphasizing due to increasing prevalence of rheumatoid arthritis RA in old age. However, they tend to be inadequately represented in RA clinical trials because of the exclusion criteria that are commonly applied. The tolerability and safety of TNF inhibitors in elderly patients have not been also evaluated in clinical practice. This study aimed to evaluate the retention rate and safety of TNF inhibitors TNFI in elderly RA patients.

MethodsTotal 429 RA patients 838 person-years PYs treated with TNFI from a retrospective biologic DMARDs registry. Patients were divided into an elderly age ≥60 years and a younger group <60 years. The drug retention rates of both groups were compared using Kaplan-Meier curves. Potential predictors of TNFI discontinuation in the elderly were examined using Cox regression analysis. The incidence rate IR of serious adverse events SAEs in the elderly group was compared to that of the young group.

ResultsOf the patients, 24.9 % n = 107, 212 PYs were in the elderly group. Regarding the retention rates of TNFI in 3 years, there was no significant difference between the elderly and younger group p = 0.33. The major cause of discontinuation in elderly patients was AE 34.3 %, whereas that was drug ineffectiveness 41.7 % in younger patients. Age HR 1.09, CI 1.02-1.16 was a predictor of discontinuation, while the presence of comorbidity HR 0.37, CI 0.15-0.91 had a protective effect against drug discontinuation in the elderly. The IR of SAEs in the elderly 6.13-100 PYs was higher than in the younger group 5.11-100 PYs.

ConclusionsThe retention rate of TNFI in the elderly was comparable with that in younger patients. The major cause of discontinuation in the elderly patients was AEs, while it was drug ineffectiveness in younger patients. The IR of SAEs in the elderly was higher than in the younger patients.

KeywordsRheumatoid arthritis TNF inhibitor Elderly Safety Drug retention rate Electronic supplementary materialThe online version of this article doi:10.1186-s12891-016-1185-6 contains supplementary material, which is available to authorized users.

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Autor: Soo-Kyung Cho - Yoon-Kyoung Sung - Dam Kim - Soyoung Won - Chan-Bum Choi - Tae-Hwan Kim - Jae-Bum Jun - Dae-Hyun Yoo - San

Fuente: https://link.springer.com/







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