Treatment of active rheumatoid arthritis: comparison of patients younger vs older than 75 years (CORPUS cohort)

Oishi, Sachiyo; Wendling, Daniel; Sibilia, Jean; Job-Deslandre, C; Guillevin, Loı̈c; Bénichou, Jacques; Flipo, R.M.; Duquenne, Carole; Guillemin, Françis; Saraux, Alain

doi:10.1080/21645515.2018.1522470

Cited by 4 publications

(8 citation statements)

References 26 publications

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“… 26 bDMARDs were introduced during the collection of the BARFOT cohort, which means that only the patients included during 1999–2006 (about half of the patients) had access to treatment with bDMARDs. As seen in other studies, 11–14 the prescription of bDMARDs was highest for younger patients and decreased with age at onset. GC in monotherapy was used in < 20% of the patients, however, the patients who were most likely to receive this treatment were women and men ≥ 70 years.…”

Section: Discussionsupporting

confidence: 84%

“…3 One possible explanation for GC as monotherapy is the occurrence of comorbidities, since RA patients with late onset have a heavier burden of comorbidities compared with younger ones. 11 Notably, GC treatment has been reported to be more common in patients with late onset. 11,12 Access to bDMARDs and targeted synthetic DMARDs have improved the disease outcome immensely and today the treatment aim is clinical remission, or at least low disease activity.…”

Section: Discussionmentioning

confidence: 99%

“…11 Notably, GC treatment has been reported to be more common in patients with late onset. 11,12 Access to bDMARDs and targeted synthetic DMARDs have improved the disease outcome immensely and today the treatment aim is clinical remission, or at least low disease activity. 7 The perfect treatment is an act of balance between too little and too much immunosuppression, and particularly among older RA patients there is often a tension between the likely benefit of treating the active disease and the risk of adverse events due to frailty or comorbidities.…”

Section: Discussionmentioning

confidence: 99%

“…5 International treatment guidelines recommend that treatment with disease modifying anti-rheumatic drugs (DMARDs) at diagnosis, irrespective of sex and age and the presence of poor prognostic factors, should be pursued actively. 6,7 Although the guidelines do not discriminate on the basis of sex or age, younger patients seem to receive more treatment with both conventional synthetic (cs) and biological (b) DMARDs, [8][9][10] whereas elderly patients are more likely to receive glucocorticoids (GC) only 11 and less likely to receive DMARD 12 especially bDMARDs. [11][12][13][14] Previous studies found that age at diagnosis and sex may influence the choice of treatment in RA.…”

Section: Introductionmentioning

confidence: 99%

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Influence of Age and Sex on Disease Course and Treatment in Rheumatoid Arthritis

Nilsson¹,

Andersson²,

Hafström³

et al. 2021

OARRR

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More than 50% of patients with rheumatoid arthritis (RA) are >65 years at diagnosis. Age of onset and sex may influence the disease course, outcome and treatment. This study follows a large cohort of patients with early RA to assess contributions of age and sex to disease outcomes. Methods: Patients from the BARFOT cohort, n=2837 (68% women), were followed for eight years at predefined time points to assess inflammation, function, joint destruction and treatment with disease modifying anti-rheumatic drugs (DMARDs) and glucocorticoids (GC). The patients were divided by sex and age at inclusion (<40, 40-54, 55-69 and ≥70 years). Results: For both sexes, disease activity, function and pain improved over time, significantly more in men than in women in all age groups. In men, those <40 years displayed significantly lower DAS28 compared with all other groups. This group was also the least represented group in the study. The Sharp van der Heijde Score (SHS) increased over time in both sexes and all age groups. Women ≥70 years showed less improvement in disability and the highest progression of SHS mainly due to increased joint space narrowing. Patients <40 years were more likely to receive biological DMARDs, while those ≥70 years more often received only GC treatment. Conclusion: There were significant age-and sex-dependent differences in the medical treatment and in outcome of RA 8 years after diagnosis. The differences were most pronounced in men<40 and women ≥70 years, but whether they are due to disease phenotype or treatment is unclear.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Influence of Age and Sex on Disease Course and Treatment in Rheumatoid Arthritis

Nilsson¹,

Andersson²,

Hafström³

et al. 2021

OARRR

View full text Add to dashboard Cite

show abstract

“…Age plays a substantial role in sepsis; however, the impact of age on incident infection in patients with RA appears to vary with studies due to the distinct target to treat strategy, use of b/tsDMARDs, and concomitant GCs (20)(21)(22). Increasing evidence has shown that the concern regarding the safety issue of b/tsDMARDs in elderly patients with RA might somehow deprive those patients of optimal disease control and quality of life (20).…”

Section: Discussionmentioning

confidence: 99%

Association of Hospitalised Infection With Socioeconomic Status in Patients With Rheumatoid Arthritis Receiving Biologics or Tofacitinib: A Population-Based Cohort Study

et al. 2021

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Objectives: Use of biologics or targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) is associated with infection in patients with rheumatoid arthritis (RA). Socioeconomic status is substantial in infectious diseases; however, the impact of socioeconomic status on risk for infection in patients with RA receiving b/tsDMARD remains unclear.Methods: We used the 2003–2017 Taiwanese National Health Insurance Research Database to identify patients with RA receiving b/tsDMARDs. A Cox regression analysis was used to estimate the associations of covariates with the risk of hospitalised infection shown as hazard ratios (HRs) with 95% confidence interval (CIs).Results: We identified 7,647 RA patients who started their first bDMARD/tsDMARD treatment. Log-rank analyses demonstrated the association between age (p < 0.001), urbanisation (p = 0.001), the insured amount (p = 0.021), and the hospitalisation. Cox proportional regression analyses showed that age was independently associated with hospitalised infection in a dose–response manner, whereas a high-income category had an inverse association (HR 0.48, 95% CI 0.23–0.96). Hospitalisation for infection within 5 years was a strong risk factor (HR 5.63, 95% CI 1.91–16.62), and living in a rural area tended to be a risk factor (HR 1.76, 95% CI 0.98–3.14) for incident hospitalised infection.Conclusions: This study showed the crucial impacts of age, socioeconomic status, and history of infection on hospitalised infection in patients with RA receiving b/tsDMARDs. These findings highlight the largely ignored role of socioeconomic status in risk stratification among patients receiving b/tsDMARDs for RA.

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Disease-modifying drug retention rate according to patient age in patients with early rheumatoid arthritis: analysis of the ESPOIR cohort

Mathieu¹,

Pereira²,

Saraux

et al. 2021

Rheumatol Int

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Physicians are sometimes hesitant to use disease-modifying antirheumatic drugs (DMARDs) in elderly patients with rheumatoid arthritis (RA), as they are deemed too fragile, although there are no sufficient scientific evidence. We aimed to compare DMARD treatment retention in early RA patients from the ESPOIR cohort, according to age upon inclusion. Overall, treatment retention was evaluated as the percentage of patients whose DMARDs were not stopped, with stratification by age group: < 50, 50-64, and > 65 years. Survival curves were measured using the Kaplan-Meier method. Of the entire ESPOIR cohort (n = 813), 7% were > 65 years old. Methotrexate (MTX) was used by 521 patients, and was the sole DMARD for 198 patients. MTX treatment retention appeared better in patients > 65 years old compared to < 50 years old [HR 0.45 (0.25; 0.81); p = 0.008, n = 195/198] with adjustment on sex, smoking, positive anti-cyclic citrullinated peptide antibodies, positive rheumatoid factor, body mass index, changes in DAS28 and corticosteroid treatment. The proportion of patients using etanercept (n = 111), and this drug's retention rate, did not differ according to patient age. The proportion of patients treated with adalimumab (n = 104) was significantly higher in patients < 50 years old (p = 0.003), and treatment retention was marginally better among younger patients [HR 1.68 (0.88; 3.22), p = 0.12]. Within the ESPOIR cohort, DMARD retention did not appear to differ according to age-except for better retention of MTX treatment in patients 50-64 years old, and of adalimumab in patients < 50 years old.

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Treatment of active rheumatoid arthritis: comparison of patients younger vs older than 75 years (CORPUS cohort)

Cited by 4 publications

References 26 publications

Influence of Age and Sex on Disease Course and Treatment in Rheumatoid Arthritis

Influence of Age and Sex on Disease Course and Treatment in Rheumatoid Arthritis

Association of Hospitalised Infection With Socioeconomic Status in Patients With Rheumatoid Arthritis Receiving Biologics or Tofacitinib: A Population-Based Cohort Study

Disease-modifying drug retention rate according to patient age in patients with early rheumatoid arthritis: analysis of the ESPOIR cohort

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