Dataset Information

Effectiveness and safety of treat-to-target strategy for methotrexate-naive rheumatoid arthritis patients >75 years of age.

ABSTRACT:

Objectives

To identify differences in effectiveness and safety of a treat-to-target (T2T) strategy comparing late-onset MTX-naïve RA patients (LORA) ≥75 or <75 years of age.

Methods

Treatment was adjusted to target low disease activity with conventional synthetic DMARDs followed by biologic DMARDs (bDMARDs) in LORA ≥75 years (n = 98, mean age 80.0 years) and LORA <75 years (n = 99) with moderate-high disease activity. Achievement of Simplified Disease Activity Index (SDAI) remission at week 156 by non-responder imputation analysis was evaluated as a primary outcome.

Results

LORA ≥75 years had more comorbidities than LORA <75 years, but SDAI and ACPA positivity were similar at baseline. Of the LORA ≥75 years, 70.4% started MTX and 34.1% and 37.1% received a bDMARD at week 52 and 156, respectively (very similar to the LORA <75 years). Glucocorticoid use was more frequent in the LORA ≥75 years than in the LORA <75 years. Comorbidities/adverse events more frequently contributed to the reasons for non-adherence to T2T in the LORA ≥75 than in the LORA <75. At week 156, 32.7% of the LORA ≥75 and 66.7% of the LORA <75 achieved SDAI remission (P < 0.001). The cumulative incidence of serious adverse events (SAEs) over 156 weeks was 42.8% in the LORA ≥75 and 22.1% in the LORA <75. Multivariable analysis indicated an increased risk of SDAI non-remission at week 156 in the LORA ≥75 [odds ratio 2.82 (95% CI 1.29. 6.14)] after adjusting for comorbidities at baseline, non-adherence to T2T and SAEs.

Conclusions

It was more difficult to achieve remission in the LORA ≥75 patients than in the LORA <75 patients due to both poor treatment response and safety issues.

SUBMITTER: Matsumoto T

PROVIDER: S-EPMC10904149 | biostudies-literature | 2024

REPOSITORIES: biostudies-literature

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Publications

Effectiveness and safety of treat-to-target strategy for methotrexate-naïve rheumatoid arthritis patients >75 years of age.

Matsumoto Takumi T Sugihara Takahiko T Hosoya Tadashi T Ishizaki Tatsuro T Kubo Kanae K Kamiya Mari M Baba Hiroyuki H Tsuchida Marina M Hirano Fumio F Kojima Masayo M Miyasaka Nobuyuki N Harigai Masayoshi M

Rheumatology advances in practice 20240209 1

<h4>Objectives</h4>To identify differences in effectiveness and safety of a treat-to-target (T2T) strategy comparing late-onset MTX-naïve RA patients (LORA) ≥75 or <75 years of age.<h4>Methods</h4>Treatment was adjusted to target low disease activity with conventional synthetic DMARDs followed by biologic DMARDs (bDMARDs) in LORA ≥75 years (<i>n</i> = 98, mean age 80.0 years) and LORA <75 years (<i>n</i> = 99) with moderate-high disease activity. Achievement of Simplified Disease Activity Index ...[more]

PMID: 38425693

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