Differential long-term retention of biological disease-modifying antirheumatic drugs in patients with rheumatoid arthritis by age group from the FIRST registry

Abstract

Background. The effectiveness and safety of biological disease-modifying antirheumatic drugs (bDMARDs) by age group (<65, 65–74, and ≥75 years) are uncertain. We examined retention rates reflecting the effectiveness and safety of bDMARDs in actual clinical practice for clarifying optimal therapeutic strategies for rheumatoid arthritis (RA) by age groups.Methods. Data of patients who were treated with tumor necrosis factor inhibitors (TNFi), abatacept (ABA), and tocilizumab (TCZ) between February 2011 and April 2017 were collected from a prospective observational registry of RA patients. A total of 1,362 patients were enrolled, of which 695 were aged <65 years, 402 were aged 65–74 years, and 265 were aged ≥75 years. Primary outcome was the drug retention rate in adjusted data using inverse probability of treatment weighting based on generalized propensity scores.Results. In patients aged <65 years, three-year retention rates of TNFi, ABA, and TCZ were 43%, 47%, and 69%, respectively (ABA versus TCZ, p = 0.017; TNFi versus TCZ, p = 0.002). In patients aged 65–74 years, three-year retention rates of TNFi, ABA, and TCZ were 44%, 53%, and 60%, respectively (TCZ versus TNFi, p = 0.034). In patients aged ≥75 years, three-year retention rates for TNFi, ABA, and TCZ were 38%, 63%, and 58%, respectively (ABA versus TNFi, p = 0.017).Conclusions. We found that the effectiveness and safety of TCZ were maximal in patients aged <75 years and that patients aged ≥75 years might be suitable candidates for TCZ and ABA therapy. The use of therapeutic strategies appropriate to each age group might improve the outcomes of bDMARD therapy for RA.

Long-Term Durability of Certolizumab Pegol in Patients with Rheumatoid Arthritis Over 5 Years: An Analysis of Pooled Clinical Trial Data

“…Lower rates of CZP retention among patients aged C 65 years were observed compared with patients aged \ 65 years-a trend that has also been observed in RA patients on other bDMARDs [12]. Specifically, patients C 65 years were more likely to discontinue CZP treatment due to AEs [14,24,25,32].…”

“…In a real-world retrospective study comparing drug retention rates of seven bDMARDs (including certolizumab pegol [CZP]) among RA patients, 3-year retention rates ranged from 31.1 to 60.7% [7]. Retention rates among TNFi specifically have been reported to vary across different patient subgroups in real-world studies; female sex, older age, concomitant prednisolone, and absence or low dose of combined MTX have been associated with a greater likelihood of TNFi discontinuation [9][10][11][12][13]. The reasons for bDMARD discontinuation have also been noted to differ within a given patient subgroup; for example, among patients stratified by age, inadequate levels of efficacy were more commonly cited among those aged \ 60 years compared with those aged C 60 years [14].…”

Comparison of the drug retention and reasons for discontinuation of Tumor Necrosis Factor Inhibitors and Interleukin-6 Inhibitors in patients with Elderly-onset Rheumatoid Arthritis-the ANSWER cohort study

“…Thus, cohort-based observational studies may be more suitable to investigate the performance of bDMARDs among unique population such as EORA. There have been a few observational studies comparing the effectiveness of bDMARDs among elderly patients with RA [12,13]. These studies included not only EORA but young-onset RA who had relatively long disease duration.…”