Older Age at Rheumatoid Arthritis Onset and Comorbidities Correlate With Less Health Assessment Questionnaire–Disability Index and Clinical Disease Activity Index Response to Etanercept in the RADIUS 2 Registry

Abstract

Background Controversy exists in understanding the effects of age of onset and comorbidities in predicting rheumatoid arthritis (RA) response to biologic therapy. Objective To investigate the influence of age of onset and number of comorbidities on Health Assessment Questionnaire-Disability Index (HAQ-DI) and Clinical Disease Activity Index (CDAI) responses in active RA patients after 6 months of treatment with etanercept. Methods 1899 RA patients were assessed after 6 months of etanercept therapy. Patients met the following inclusion criteria: initiated etanercept, continued therapy for at least 6 months, and were not in CDAI low disease activity at baseline (CDAI≤10.0). Changes in HAQ-DI and CDAI scores over 6 months were analyzed across age quintiles. Multivariate regression models evaluated the independent association between both age of onset and number of comorbidities with change in HAQ‐DI/CDAI scores or achieving low disease activity, while accounting for other covariates. Results Significant improvements in HAQ-DI and CDAI scores were observed in all age-onset groups, although HAQ-DI improvements were less in older‐onset patients. Results of multiple linear regression demonstrated that younger age at onset, higher baseline HAQ-DI/CDAI score, rheumatoid factor positivity, shorter disease duration, and fewer comorbidities at baseline were independently associated with improvement in both HAQ-DI and CDAI scores. Similarly, achieving CDAI LDA after ≥6 months of etanercept was associated with younger age of onset, higher baseline CDAI, shorter disease duration, and fewer comorbidities. Conclusions Patients with older-onset RA and more comorbidities clinically improved with etanercept, but had lower odds of achieving CDAI LDA. Age of onset and number of comorbidities may be important in determining RA tumor necrosis factor (TNF)-inhibitor response.

Influence of baseline modified Rheumatic Disease Comorbidity Index (mRDCI) on drug survival and effectiveness of biological treatment in patients affected with Rheumatoid arthritis, Spondyloarthritis and Psoriatic arthritis in real‐world settings

“…10,11 Another perspective of analysis in this field is the possible impact of comorbidities on clinical response in patients with RA, PsA and SpA under treatment with biological drugs. 12,13 This approach has been widely used to assess the influence of a single comorbid disease, like obesity. 14 However, in the settings of real-life patients may often suffer from more comorbid conditions, and this raises the need of a whole assessment of comorbidities.…”

“…The interest in the relationships between rheumatic diseases and comorbidities has further increased since the arrival onto the market of biological drugs with the concern that the selective blocking of tumour necrosis factor (TNF) or interleukin‐6 (IL‐6) may deteriorate the cardiac output or alter the lipid metabolism ensuing in a higher cardiovascular risk . Another perspective of analysis in this field is the possible impact of comorbidities on clinical response in patients with RA, PsA and SpA under treatment with biological drugs . This approach has been widely used to assess the influence of a single comorbid disease, like obesity .…”

The first biological choice in patients with rheumatoid arthritis: data from the Moroccan register of biotherapies

“…Monti S et al (13) revealed that age and comorbidities in uence the choice towards ABA and TCZ compared to TNFi. Previous studies indicated that age and the presence of comorbidities are associated with a decreased response by Etanercept (19,20). Frisell T et al (7) reported that patients receiving TNFi were younger than the non-TNFi group.…”

Risk factors associated with inadequate control of disease activity in elderly patients with rheumatoid arthritis: Results from a nationwide KOrean College of Rheumatology BIOlogics (KOBIO) registry

“…In line with these findings, comorbidity was an independent risk factor for uncontrolled disease activity in the whole study population. Comorbidity was previously known to have an independent association with clinical measures, such as the CDAI and the Health Assessment Questionnaire [ 23 , 24 ]. We also found that the presence of comorbid disease has a significant correlation with disease activity indices, including DAS28.…”