Tolerance and effectiveness of anti–tumor necrosis factor α therapies in elderly patients with rheumatoid arthritis: A population‐based cohort study |
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| Authors: | Stéphane Genevay Axel Finckh Adrian Ciurea Anne‐Marie Chamot Diego Kyburz Cem Gabay |
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| Institution: | 1. University Hospitals of Geneva, Geneva, Switzerland;2. Drs. Genevay and Finckh contributed equally to this study.;3. Dr. Genevay has received speaking fees (less than $10,000) from MSD and Abbott.;4. Dr. Finckh has received an unrestricted grant from Wyeth and a research grant from the Swiss Society of Rheumatology sponsored by Abbott.;5. Rheumaklinik und Institut für Physikalische Medizin, Universit?tsspital Zürich, Zürich, Switzerland;6. Rheumatology Private Practice, Morges, Switzerland;7. Dr. Gabay has received consulting fees and/or honoraria (less than $10,000) from Abbott, Wyeth, Essex, and Roche. |
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| 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. |
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| Keywords: | Rheumatoid arthritis Elderly Anti– tumor necrosis factor |
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