Outcomes with Biological Disease-Modifying Anti-Rheumatic Drugs (bDMARDs) in Older Patients Treated for Rheumatoid Arthritis

  • Ripa Akter University of Calgary
  • Walter P. Maksymowych University of Alberta
  • M. Liam Martin University of Calgary
  • David B. Hogan University of Ottawa
Keywords: late onset rheumatoid arthritis, rheumatoid arthritis, older age, biological disease-modifying anti-rheumatic drugs, adverse events, effectiveness, safety

Abstract

Background

Biological disease-modifying antirheumatic drugs (bDMARDs) are recommended for rheumatoid arthritis (RA), but older patients reportedly experience more adverse events (AEs) and show variable treatment response. The objective of this study was to evaluate AEs and effectiveness of bDMARDs in a cohort of older patients.

Methods

AE and treatment effectiveness (based on DAS28 scores) data from a prospective provincial pharmacovigilance program for the years 2006–2009 in patients 55–64, 65–74, and 75+ years of age were compared. An intention to treat analysis with chisquare and unpaired t-testing for significance was performed.

Results

There were a total of 333 patients (156 were aged 55–64, 125 were 65–74, 52 were 75+). Those 75+ had higher disease activity and worse functional status at baseline. Among those 75+, AEs with bDMARDs were more common and likely to lead to discontinuation of therapy, be graded as severe, and classified as infectious (p < .05). Remission rate among those 75+ was significantly higher than patients 65–74. Etanercept was the most commonly used drug in all age groups.

Conclusion

Patients 75+ treated with bDMARDs are at a significantly greater risk of AEs, including infectious ones. The higher remission found in the oldest age group warrants further study.

Author Biographies

Ripa Akter, University of Calgary

MD, FRCPC

Geriatrics 

Walter P. Maksymowych, University of Alberta

Division of Rheumatology, Department of Medicine, Faculty of Medicine & Dentistry

M. Liam Martin, University of Calgary

Division of Rheumatology, Department of Medicine, Cumming School of Medicine

David B. Hogan, University of Ottawa

Geriatrics, Internal Medicine, Division of Geriatric Medicine

Published
2020-03-05
How to Cite
Akter, R., Maksymowych, W. P., Martin, M. L., & Hogan, D. B. (2020). Outcomes with Biological Disease-Modifying Anti-Rheumatic Drugs (bDMARDs) in Older Patients Treated for Rheumatoid Arthritis. Canadian Geriatrics Journal, 23(2), 184-189. https://doi.org/10.5770/cgj.23.393
Section
Original Research