Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Biological Agent Safety in Older vs Younger Patients

Semin Arthritis Rheum; ePub 2018 Jul 31; Dalal, et al

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.

This Week's Must Reads

Decreasing Trend of Age-Adjusted Mean BMD Observed, Osteoporos Int; ePub 2018 Aug 8; Xu, Wu

Pain Severity and Depression in Knee OA Examined, Osteoarthritis Cartilage; ePub 2018 Aug 6; Rathbun, et al

Smoking, Alcohol, and SLE Incidence Link Examined, Arthritis Care Res; ePub 2018 Aug 9; Cozier, et al

SLE Damage Compared in 2 Cohorts of Dominicans, Lupus; ePub 2018 Aug 9; Geraldino-Pardilla, et al

Resistance Training May Help Minimize Hip Bone Loss, J Bone Miner Res; ePub 2018 Aug 7; Beavers, et al

Must Reads in Rheumatoid Arthritis

Pain and Catastrophizing in Patients with RA, J Clin Rheumatol; ePub 2018 Jun 22; Cohen, et al

Delay in DMARD Initiation in Newly Diagnosed RA, Semin Arthritis Rheum; ePub 2018 Jul 18; Kimsey, et al

Fatigue an Overall Problem for Patients with RA, Rheumatol Int; ePub 2018 Jul 16; Walter, et al

Biological Agent Safety in Older vs Younger Patients, Semin Arthritis Rheum; ePub 2018 Jul 31; Dalal, et al

Higher Body Fat, Obesity in Women Linked with RA, Arthritis Care Res; ePub 2018 Jul 5; Linauskas, et al