Elderly psoriatic arthritis patients on TNF-α blockers: results of an Italian multicenter study on minimal disease activity and drug discontinuation rate

Abstract

Psoriatic arthritis (PsA) is an inflammatory arthropathy, associated with skin and/or nail psoriasis. Real world data on efficacy and safety of TNF-α blockers in the elderly with PsA are lacking. The aim of this study was to evaluate the effectiveness, through the achievement of minimal disease activity (MDA), drug discontinuation rate, and safety in elderly patients with PsA on TNF-α blockers. A multicenter, observational study was carried out in four Italian centers. The assessment of disease activity and safety were performed at the start of anti-TNF-α (T0), at 6 months (T6) and at 12 months (T12). A total of 145 PsA patients were included in the study. At baseline 68 (46.9%) patients were on etanercept, 60 (41.3%) on adalimumab, 11 (7.6%) on golimumab, and 6 (4.1%) on infliximab. All the variables concerning PsA activity showed a statistically significant improvement when comparing T6 and T12 with T0. After 6 and 12 months of therapy, respectively, 31 (22.6%) and 71 (51.8%) patients achieved MDA (p < 0.001). The drug discontinuation rate was 5.5% with a mean of 6.8 months (range 2-10 months), and it was due to lack of efficacy, adverse events, and lost to follow-up. Nine patients (6.2%) reported the onset of mild infections resolved with antimicrobial specific oral regimen without therapy interruption. TNF-α blockers are effective in the achievement of a low disease status and safe in elderly patients with PsA. Therefore, age should not be considered a limitation to their use.

Safety of Biologic Therapy in Older Patients With Immune-Mediated Diseases: A Systematic Review and Meta-analysis

“…18 Thirteen studies were excluded because they did not have sufficient data for the control population. [19][20][21][22][23][24][25][26][27][28][29][30][31] Thus, our final analysis included 14 unique studies. [7][8][9][32][33][34][35][36][37][38][39][40][41][42] Of these, 3 studies had only the abstract available for review, but sufficient detailed information could be extracted to allow for inclusion.…”

Does Age Matter in Psoriatic Arthritis? A Narrative Review

“…In patients with psoriatic disease, the limited data appear to be more consistent. Costa et al reported that treatment with anti-TNF agents had good efficacy, comparable -indirectly-with that seen in younger patients with PsA (50). Similarly, in a long-term observational study, etanercept and adalimumab were safe and efficacious for the treatment of elderly patients (aged≥65 years) with psoriasis and PsA (51) and in a large retrospective study, Migliore et al (47) reported that infliximab, adalimumab and etanercept were safe options in people with inflammatory arthritis (including patients with RA, ankylosing spondylitis and PsA) who were aged 65 years or more.…”

<p>An Update for the Clinician on Biologics for the Treatment of Psoriatic Arthritis</p>

“…Additionally, in this study, a good safety profile was reported. 187 When appropriate, APR can be useful and relatively safe. On the contrary, data on tofacitinib in elderly patients are very few, and, among those, age older than 65 years has been reported as an independent predictor of increased risk of serious infections.…”

“… 186 Moreover, csDMARDs effectiveness and safety derived from randomized placebo-controlled trials (RCTs) and longitudinal observational cohorts are scarce and mainly focused on methotrexate and sulfasalazine. 187 Esposito et al 188 retrospectively evaluated the effectiveness and safety of subcutaneous etanercept and adalimumab in 89 elderly patients with PsO and PsA, aged between 65 and 82 years (mean age 69.7 years). The results showed that TNF-i are appropriate in the long-term management of elderly patients.…”