Effectiveness and safety of biologic and targeted synthetic disease-modifying anti-rheumatic drugs in elderly patients with rheumatoid arthritis: real-world data from the KOBIO Registry

Abstract

ObjectiveWe aimed to evaluate the clinical outcomes and safety of biologic and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) and to identify predictors of treatment responses to b/tsDMARDs in elderly patients with rheumatoid arthritis (RA). MethodsData from the nationwide cohort of elderly (≥ 65 years) patients enrolled in the KOBIO Registry were analysed. Clinical outcomes were assessed, including changes in the Simplified Disease Activity Index, after treatment. Adverse events and reasons for drug discontinuation were assessed. Multivariable logistic regression analyses were performed to determine which baseline variables affected treatment responses and adverse events (AE). ResultsElderly patients treated with b/tsDMARDs (n=355) or conventional synthetic DMARDs (csDMARDs) (n=104) were included. The median age was 70 years and 77% were female. After 1 year, 63% of patients in the b/tsDMARD group and 68% in the csDMARD group achieved remission or low disease activity (LDA). Overall, 27% of patients in the b/tsDMARDs group and 24% in the csDMARDs group experienced AE. A total of 43.4% of patients on b/tsDMARDs discontinued therapy due to lack of effectiveness (27%), AE (34%), or other reasons (35%). The estimated median retention of b/tsDMARDs was 2.5 years. Male sex and non-exposure to tobacco at baseline were independent factors associated with achieving remission or LDA after 1 year. Interstitial lung disease (ILD) was the most prominent comorbidity associated with AE. ConclusionTreatment with b/tsDMARDs is effective and well tolerated in elderly patients with RA; nonetheless, ILD is a key comorbidity that should be monitored carefully.

Safety of synthetic and biological DMARDs: a systematic literature review informing the 2022 update of the EULAR recommendations for the management of rheumatoid arthritis

“…From a total of 2961 references (after de-duplication), 226 were selected for a full-text review and 59 observational studies fulfilled the inclusion criteria 16–74. In addition, 2 RCTs with a primary safety outcome,2 3 and 28 RCTs/LTEs from the efficacy SLR,75–102 were included (flow chart in online supplemental figure S1).…”

“…Of 59 observational studies, 51 assessed only 1 outcome,16–66 and 8 addressed ≥2 outcomes (online supplemental table S1–137). 67–74 Of 27 studies evaluating the risk of infections,27–47 67 69 71–74 23 included patients on bDMARDs,27–29 31–33 35–37 39–47 69 71–74 9 of which also patients on JAKi,27 28 30 31 42 45 69 71 72 3 only patients on csDMARDs34 38 67 and 1 patients either on tofacitinib or on csDMARDs 30.…”

“…Seven studies addressed withdrawals due to adverse events with bDMARDs54–56 63–66 and one with JAKi 57. One study assessed any serious adverse events,67 another any adverse event,16 both in patients with bDMARDs, and one evaluated pregnancy outcomes in patients on bDMARDs 62…”

Factors influencing choice of b/ts DMARDs in managing inflammatory arthritis from a patient perspective: a systematic review of global evidence and a patient-based survey from Hong Kong

“…Evidence from randomised clinical trials and real-life post-marketing records indicates that b/ts DMARDs are effective, with the potential to optimise their use in setting up personalised treatment and achieving treat-to-target strategies in disease management 6 7. The safety of b/ts DMARDs is also acceptable and manageable, particularly compared with the risks associated with the disease itself 8–10.…”

Not all geriatric cachexia is cancer – The difficult lateonset rheumatoid arthritis

“…In this case, IV Infliximab (TNF-α inhibitor) turned out to be a logic option, controlling as early as possible the LORA activity. [ 6 , 7 , 8 , 9 , 10 ]…”