Tolerance and effectiveness of anti-tumor necrosis factor α therapies in elderly patients with rheumatoid arthritis:: A population-based cohort study

Objective. Limited data have been published on tolerance to and efficacy of classic or biologic disease-modifying antirheumatic drugs in elderly patients with rheumatoid arthritis (RA). The goal of the present study was to evaluate the tolerance to and effectiveness of anti-tumor necrosis factor (anti-TNF) agents in elderly patients (>= 65 years old) with RA (ERA) in comparison with younger patients (YRA). Methods. The Swiss Clinical Quality Management program for RA is a longitudinal population-based cohort. All patients who had received at least 1 dose of anti-TNF agents between January 1997 and November 2005 were included and categorized according to their age. Tolerance was assessed by analyzing discontinuation rates of anti-TNF agents. Effectiveness of these agents was assessed by analyzing RA disease activity (Disease Activity Score in 28 joints [DAS28]) and functional disability (Health Assessment Questionnaire [HAQ]) after anti-TNF initiation. Results. Among 1,571 patients with RA treated with anti-TNF agents, 344 were 2:65 years of age at treatment initiation. Drug discontinuation rates (median time 3 years) and mean change in DAS28 scores at 2 years (-0.65 versus -0.58) were identical in ERA and YRA. However, HAQ score improved significantly less in ERA (-0.02) than in YRA (-0.1) and a subsequent analysis revealed that this finding was essentially due to patients > 75 years of age. Conclusion. Age in itself should not interfere with the decision to treat elderly patients with RA with anti-TNF agents. In a subset of patients ages > 75 years, no functional improvement according to HAQ should be expected despite improvements in disease activity.