Older patients with rheumatoid arthritis (RA) had worse safety and efficacy with biological agents but also had worse baseline disease activity, according to a recent study. A comprehensive, systematic search was conducted in major indexing databases using key terms for RA and each biological agent. Investigators randomized controlled trials and included observational studies of at least 6-month duration conducted in adult RA patients. Outcomes of interest were clinical efficacy and safety. They found:
- 24 studies (16 focusing on anti-TNF agents) representing 63,705 patients (24% were older) were included.
- Older RA patients had worse baseline RA disease activity, longer disease duration at the time of enrollment in the trial (14.4±3.6 vs 10.9±3.6 years), and higher steroid use (73.2% vs 64.7%) than younger.
- 5 out of 6 studies assessing anti-TNF agents showed worse efficacy outcomes in older patients.
- The pooled odds ratio (OR) of infection and adverse drug reactions with anti-TNF agents in older compared to young RA patients was OR 1.59 and 1.40, respectively.
Dalal DS, Duran J, Brar T, et al. Efficacy and safety of biological agents in the older rheumatoid arthritis patients compared to young: A systematic review and meta-analysis. [Published online ahead of print July 31, 2018]. Semin Arthritis Rheum. doi:10.1016/j.semarthrit.2018.07.009.
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