Effectiveness and safety of abatacept in elderly patients with rheumatoid arthritis enrolled in the French Society of Rheumatology’s ORA registry

Lahaye, Clément; Soubrier, Martin; Mulliez, Aurélien; Bardin, Thomas; Cantagrel, A.; Combe, Bernard; Dougados, Maxime; Flipo, René‐Marc; Loët, Xavier Le; Shaeverbeke, T.; Ravaud, Philippe; Mariette, Xavier; Gottenberg, Jacques-Éric

doi:10.1093/rheumatology/kev437

Cited by 55 publications

(37 citation statements)

References 34 publications

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“…The overall incidence of malignancies in the clinical development program of abatacept was not higher than expected in similar rheumatoid arthritis cohorts [99]. According to Lahaye, in patients treated with abatacept, the rate of adverse effects, especially serious infection increases with age [83], the most common infection sites being in bronchopulmonary, genitourinary systems and the joints.…”

Section: Abataceptmentioning

confidence: 91%

“…Again, little information is available on the subpopulation of elderly patients. The age does not seem to influence the drug survival, with averagely tree-quarters of patients stopping their treatment at least once in a 24 month period in all age groups (<65 years, 64-74 years and ≥ 75 years) [83]. However, the discontinuation for lack of effectiveness decreases and discontinuation for adverse effects increases with age.…”

Section: Abataceptmentioning

confidence: 96%

“…The concept of blocking the IL-6 pathway in the older RA patients could provide a theoretical advantage, taking into account age-related pro-inflammatory changes, often higher baseline disease activity and higher CRP levels observed in the elderly [82,83]. Surprisingly for this assumption, younger age seems to be predictive of good EULAR response [81].…”

Section: Tocilizumabmentioning

confidence: 99%

“…Data about the use of abatacept in the elderly population with rheumatoid arthritis are scarce. Based on the limited available data sets age does not seem to influence the drug's effect on disease activity [93,83].…”

Section: Abataceptmentioning

confidence: 99%

“…Having a higher baseline activity, the very elderly had a lower probability of good response at 6 months, but at 12 months the difference was no longer statistically significant [83]. Drug survival rates from extension cohorts of the clinical trials and different cohorts under study indicate relatively low short term discontinuation rates [93][94][95][96][97][98].…”

Section: Abataceptmentioning

confidence: 99%

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Safety and Efficacy of Biological Disease-Modifying Antirheumatic Drugs in Older Rheumatoid Arthritis Patients: Staying the Distance

Ishchenko

Lories

2016

Drugs Aging

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The population of elderly individuals with rheumatoid arthritis is rapidly expanding, mainly due to the increased life expectancy. While targeted biological therapies are well established for the treatment of this disease, their use may be lower in elderly (> of 65 years old) and very elderly patients (> 75 years old) due to perceived higher risks for adverse events in this population taking into account comorbidity, polypharmacy and frailty. In this review we discuss available evidence for the use of biological therapies in this growing patient group with specific attention towards eventual reasons for biological treatment failure or withdrawal. The majority of data is found in secondary analyses of clinical trials and in retrospective cohorts. Most information is available about tumor necrosis factor (TNF) blockers. Older patients seem to have a less robust response to anti-TNF agents than a younger population, but drug survival that may considered a proxy for efficacy does not seem to be influenced by age. Despite an overall rate of adverse effects comparable to that in younger patients, elderly RA patients are at higher risk of serious infections. Other biologics appear to have an efficacy similar to anti-TNF agents, also in the elderly RA patients. Again, the drug survival rates for tocilizumab, rituximab and abatacept resemble those in young RA patients with good general tolerability and safety profiles. The cardiovascular risk and the risk of cancer, increased in RA patents and in the elderly patients, do not appear to be strongly influenced by biologicals. Key points-Biological drugs targeting specific cytokines or immune cell populations are an important part of the management strategy for rheumatoid arthritis patients, including the elderly. 3-Overall safety and tolerability in the elderly patients is very good and age should not be a critical factor to decide against biological drug use.-The drug survival rate of biologicals in the elderly RA patients is comparable to that in the young RA population.-Co-morbidities and risk of infection are important variables to assess when considering a biological drug in the elderly.-More data and specific studies are required to better position biological drug use in this particular population as current studies provide a low level of evidence. Data in patients above 75 years are still largely missing. Moreover, the group of elderly patients that were included in clinical trials may be influenced by selection bias at inclusion and not be fully representative for infections risks and other comorbidities.4

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Section: Abataceptmentioning

confidence: 91%

Section: Abataceptmentioning

confidence: 96%

Section: Tocilizumabmentioning

confidence: 99%

Section: Abataceptmentioning

confidence: 99%

Section: Abataceptmentioning

confidence: 99%

See 3 more Smart Citations

Safety and Efficacy of Biological Disease-Modifying Antirheumatic Drugs in Older Rheumatoid Arthritis Patients: Staying the Distance

Ishchenko

Lories

2016

Drugs Aging

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Similarities and differences between multiple sclerosis and type 1 diabetes

Pozzilli

Grasso

Tomassini

2021

Diabetes Metabolism Res

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Multiple sclerosis (MS) and type 1 diabetes (T1D) are chronic conditions that result from dysfunction of the immune system. Their common root in autoimmunity stimulates interest in the exploration of similarities and differences between the two diseases. Genetic susceptibility is relevant, creating a substrate, on which environmental factors act as a trigger of an aberrant immune response. Despite being both T-cell mediated disorders with a strong involvement of the humoral arm, immunomodulation is a mainstay of MS management, whereas hormone replacement therapy remains the principal approach for T1D. T1D is usually diagnosed in children and adolescents, while MS is typical of young adults. This difference has implications for disease progression and treatment. The SARS-CoV-2 pandemic and its effect on immunity may affect the prevalence of these conditions, as well as their clinical manifestation.

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Treating Rheumatoid Arthritis Through the Life Course

Serhal

Lwin

Edwards

2020

Rheumatic Disease in Geriatrics

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Effectiveness and safety of abatacept in elderly patients with rheumatoid arthritis enrolled in the French Society of Rheumatology’s ORA registry

Abstract: The effectiveness of abatacept is not affected by age, but the increased rate of side effects, especially infections, in the elderly must be taken into account.

Cited by 55 publications

References 34 publications

Safety and Efficacy of Biological Disease-Modifying Antirheumatic Drugs in Older Rheumatoid Arthritis Patients: Staying the Distance

Safety and Efficacy of Biological Disease-Modifying Antirheumatic Drugs in Older Rheumatoid Arthritis Patients: Staying the Distance

Similarities and differences between multiple sclerosis and type 1 diabetes

Treating Rheumatoid Arthritis Through the Life Course

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