Friday, 15 Feb 2019

You are here

Elder Rheumatoids Less Likely to Receive Biologics

Multiple studies have shown that elderly rheumatoid arthritis (RA) patients tend to be under-treated and receive DMARD therapies less often than younger RA patients. Now a VAMC study shows that the elderly are less likely to receive biologic agents yet are as likely to be subjected to glucocorticoid use.

A study using national US Veteran’s Affairs databases between 2005–2016 identified RA patients after their first-ever methotrexate (MTX) therapy and analyzed subsequent drug use. 

From 17,415 patients on MTX, 3263 received biologic therapy within 2 years (20.6% 2-yr incidence).  The rate of biologic use was significantly lower in older patients (aHR 0.20; 95% CI 0.16, 0.26) when comparing those ≥ 80 vs < 50 years of age. 

RA patients with comorbidities were less likely to receive biologic agents (aHR 0.79; 95% CI 0.72, 0.87) when comparing those with a Charlson score ≥ 3 vs < 3. Similarly, biologics were less often used in those with heart failure (aHR 0.68), cancer (aHR 0.78) or in nonwhite (aHR 0.79) individuals.

However, glucocorticoid use was similar across age groups and more common in patients with greater comorbidity.

This pattern of drug use in the elderly suggests practitioners are more likely to subject the elderly to more toxic glucocorticoids than to biologics, largely because of their age or confounding comorbidities.  

It is worth noting that current treatment guidelines for RA, do not discourage or encourage best practices based on age or even comorbidity limits. 

The author has no conflicts of interest to disclose related to this subject

Rheumatologists' Comments

I wonder if the researchers bothered to consider the financial aspect of this question. People on government-assisted programs such as Medicare and Medicaid do not have access to co-pay assistance programs from the manufacturers. Cost is the primary factor my patients on Medicare consider before proceeding with a biologic agent.

More Like This

No Added Benefit to MRI-Guided Therapy in Rheumatoid Arthritis

A treat-to-target (T2T) strategy to manage rheumatoid arthritis hinges on clinical metrics to optimize therapy. But investigators from Denmark have shown that using magnetic resonance imaging–guided T2T failed to improve disease activity remission rates or reduce radiographic progression.

Differing Effects of Smoking and HLA-DRB1 in Seropositive Rheumatoids

Analyses from the Swedish EIRA incident rheumatoid arthritis cohort study shows that smoking and HLA-DRB1 exert differential effects on serologically defined RA subsets - but that the strongest influence was seen in double positive (CCP+, RF+) individuals.

Update on Pregnancy Management in RA

Two recent reports offer good news to rheumatoid arthritis (RA) women who are planning to become pregnant. 

The first studies, RA women experiencing fertility issues who turn to assisted reproductive technology (ART) shows that live births were significantly lower in women with rheumatoid arthritis receiving ART treatment compared to usual rates in women without rheumatoid arthritis.

Multidisciplinary Recommendations for Rheumatoid Foot Problems

Approximately 90% of patients with rheumatoid arthritis (RA) have foot problems. A multidisciplinary panel (including 2 patients, 22 professionals (rheumatologists, rehabilitation physicians, orthopaedic surgeons, specialized nurses, podiatrists, orthopaedic shoe technicians, pedicurists, researchers) in the Netherlands set out to develop recommendations for those who treat RA foot problems. 

Does Seropositivity Change with Therapy?

A subanalysis of the early rheumatoid arthritis (RA) "IMPROVED" study has shown that changes in RA-autoantibody levels are not associated with disease activity or or long-term drug response, but instead reflect intensity of immunosuppression. Thus while autoantibody levels may be modifiable by our best therapies, modifying CCP or RF levels appears to have limited clinical relevance.