Clinical Edge

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Biologic DMARDs may benefit older adults with RA

Key clinical point: Adults aged 65-74 years and those older than 75 generally had higher rates of maintaining treatment with abatacept (Orencia) and tocilizumab (Actemra) than with tumor necrosis factor inhibitors (TNFi) over a 3-year period.

Major finding: In adjusted analyses, 3-year retention rates in patients aged 65-74 years were 44% for TNFi, 53% for abatacept, and 60% for tocilizumab (P = 0.034 for tocilizumab vs. TNFi). The retention rate of TCZ was significantly higher than that for TNFi. In patients aged ≥ 75 years, 3-year retention rates were 38% for TNFi, 63% for abatacept, and 58% for tocilizumab (P = 0.017 for abatacept vs. TNFi).

Study details: This was a prospective cohort study using data from 1,362 adults with rheumatoid arthritis in the FIRST registry.

Disclosures: The study received no outside funding. Most authors reported having financial relationships with pharmaceutical companies.


Concerns about treatment of RA in the elderly include balancing treat-to-target goals with side effects of therapy. This observational registry study of more than 1,300 patients uses drug retention rates as a marker of safety and efficacy. Tocilizumab was noted to have the highest retention among all age groups; tocilizumab and abatacept had similar rates of retention among people older than 65. However, there are several limitations to interpretation of this data: selection bias of patients likely improves apparent treatment efficacy (and decreases discontinuation due to inefficacy). Because this study only looked at pre-existing lung disease, it is difficult to know whether this information is generalizable to patients who have cancer, chronic kidney disease, or liver dysfunction. Finally, the study does not relate whether the biologic DMARDs used were first-line or later, or differentiate between patients in the registry who were naïve to biologic treatment vs. those who had previously received biologics, which could affect both efficacy and side effects. Overall, it provides reassuring information about real-world use of biologic DMARDs in different age groups, but due to study design cannot tell us which medications should be preferred among RA patients in different age groups.”

Arundathi Jayatilleke, MD

Lewis Katz School of Medicine, Temple University


Kawabe A et al. Arthritis Res Ther. 2020 June 8. doi: 10.1186/s13075-020-02233-9.