The Safety of Anti-TNF Agents in the Elderly

Migliore, Alberto; Bizzi, Emanuele; Laganà, Bruno; Altomonte, L; Zaccari, G.; Granata, M.; Canzoni, Marco; Marasini, Bianca; Massarotti, Marco; Massafra, Umberto; Ranieri, M.; Pilla, Raffaele; Martin, Luis Severino Martin; Pezza, M; Vacca, Francesca; Galluccio, A.

doi:10.1177/039463200902200218

Cited by 36 publications

(28 citation statements)

References 27 publications

(23 reference statements)

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“…In contrast, the package inserts for IFX and UST both report no overall difference in safety in the geriatric population. While some studies have found no significant differences in AE in the elderly, other observational studies on rheumatoid diseases have revealed a significantly higher number of AE in the elderly compared with younger groups . Our study focused on patients aged 75 years or above, a group considered at higher risk than younger patients.…”

Section: Discussionmentioning

confidence: 94%

Biologic treatments for elderly patients with psoriasis

Momose

Asahina

Hayashi

et al. 2017

The Journal of Dermatology

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The number of elderly patients with psoriasis is increasing in Japan. However, biologic treatment is generally considered to be challenging in elderly patients, due to their increased risk of complications compared with younger patients. Our retrospective study aimed to evaluate the safety profile and efficacy of biologics in senior elderly patients (≥75 years old) with psoriasis. The study involved a cohort of 27 patients aged 75-88 years who were being treated with biologics over a period of more than 1 year. Initial biologics administrated to were adalimumab (five cases) and ustekinumab (22 cases). Eight patients discontinued treatment: two developed cancer; one was transferred to hospital; and five others experienced either bone fracture, interstitial pneumonia, cerebral hemorrhage resulting in death, decrepitude or developed hepatopathy following prophylactic tuberculosis treatment. Efficacy, evaluated by the percentage of patients achieving 75% reduction of Psoriasis Area and Severity Index score, was 76.9% at week 16 (n = 26), 88.0% at week 24 (n = 25) and 90.5% at week 52 (n = 21). Biologic treatments thus show clear efficacy in elderly patients with psoriasis, however, the increased frequency of adverse events requires rigorous patient observation.

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Section: Discussionmentioning

confidence: 94%

Biologic treatments for elderly patients with psoriasis

Momose

Asahina

Hayashi

et al. 2017

The Journal of Dermatology

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“…Only few studies have been published on this topic [18], while the use of biological agents in elderly patients with rheumatoid arthritis has been reported in a greater number of publications including a systematic review [19,20]. This latter review showed that elderly rheumatoid arthritis patients undergoing anti-TNF treatments have a higher number of adverse events and similar efficacy when compared with younger patients.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Subcutaneous Anti-Tumor Necrosis Factor-Alpha Agents, Etanercept and Adalimumab, in Elderly Patients Affected by Psoriasis and Psoriatic Arthritis: An Observational Long-Term Study

et al. 2012

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Background: In elderly patients the management of psoriasis is challenging due to contraindications and a higher risk of side effects. Objective: Our retrospective study aimed to evaluate the long-term efficacy and safety profile of subcutaneous anti-tumor necrosis factor (anti-TNF) agents in elderly psoriatic patients. Methods: The study included 89 patients (aged ≥65 years) with plaque-type psoriasis and psoriatic arthritis treated with the subcutaneous anti-TNF-α agents etanercept or adalimumab as monotherapy for a long-term continuous period. Results: Efficacy results were consistent and stable over long-term observation, as expressed by mean Psoriasis Area and Severity Index (PASI) score variation, percentage of patients achieving PASI50 and PASI75 and by the improvement of articular indices, pain visual analogue scale (Pain-VAS) and 44-Joint Disease Activity Score (DAS44-ESR). The proportion of patients achieving PASI50 was 91.80 and 82.14% at week 156 with etanercept and adalimumab treatment, respectively, while the proportion of patients achieving PASI75 was 83.61 and 71.43% at week 156 when treated with etanercept and adalimumab, respectively. The mean DAS44-ESR score decreased from 5.80 to 0.89 and from 3.43 to 1.44 at week 156 and the mean Pain-VAS score decreased from 75.10 to 3.15 and from 71.30 to 18.26 at week 156 with etanercept and adalimumab treatment, respectively. Both treatment adherence and safety profile were good. Conclusions: Our study demonstrates that subcutaneous anti-TNF-α agents are appropriate in the long-term management of elderly patients.

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“…In the same way, tuberculosis reactivation with anti-TNF-a therapy seems to be higher in the elderly, especially in RA over the age of 60 years. The safety profile of anti-TNF-a agents in late-onset SpA has been previously discussed [61][62][63][64][65][66][67][68][69][70] and the conclusions were mixed, with no increased risk [61,62] or a higher risk of infection for these patients [63,64]. Biological agents other than anti-TNF-a agents (abatacept, rituximab, anakinra, tocilizumab) are ineffective in AS and SpA and thus are not discussed in the management of patients with late-onset SpA.…”

Section: Biological Agents and Innovative Drugs In Lateonset Spamentioning

confidence: 99%

Diagnosis and Management of Late-Onset Spondyloarthritis: Implications of Treat-to-Target Recommendations

Toussirot

2015

Drugs Aging

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Spondyloarthritis (SpA) is usually observed in young patients while onset in the elderly is less common. Late-onset forms of SpA may become more common due to longer life expectancy. The clinical spectrum of late-onset SpA is as broad as in young people, with a predominance of peripheral SpA over pure axial disease. The Assessment of SpondyloArthritis international Society (ASAS) has developed new criteria for axial or peripheral SpA that allow patients aged under 45 years at the time of disease onset to be identified. These criteria are not theoretically adapted for the classification of patients with late-onset disease but they are useful for the diagnosis. Similarly, magnetic resonance imaging (MRI) is now widely used for the early recognition of sacroiliitis or spinal inflammation in SpA, and sacroiliitis as evidenced by MRI is included in the ASAS criteria for axial SpA. Nevertheless, the utility of sacroiliac joint and/or spine inflammation as detected by MRI has mostly been described in young patients with ankylosing spondylitis, SpA, or inflammatory back pain, but not in the elderly. The management of SpA is now more focused on remission or, alternatively, low disease activity, according to the treat-to-target recommendations. Such an optimized approach to therapy is thought to improve patient outcomes and ultimately long-term quality of life. The same principles of treatment should apply in the elderly, but require certain adjustments, especially with biological agents. Tumor necrosis factor-α blocking agents are very effective in SpA, but seem slightly less effective in the elderly and are associated with an increased risk of infection in this population. A careful and rigorous evaluation is thus required before initiating these agents in elderly subjects.

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The Safety of Anti-TNF Agents in the Elderly

Cited by 36 publications

References 27 publications

Biologic treatments for elderly patients with psoriasis

Biologic treatments for elderly patients with psoriasis

Efficacy and Safety of Subcutaneous Anti-Tumor Necrosis Factor-Alpha Agents, Etanercept and Adalimumab, in Elderly Patients Affected by Psoriasis and Psoriatic Arthritis: An Observational Long-Term Study

Diagnosis and Management of Late-Onset Spondyloarthritis: Implications of Treat-to-Target Recommendations

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