Age at biologic DMARD initiation impacts adverse event risk
medwireNews: The likelihood of experiencing an adverse event (AE) after initiating treatment with a first biologic DMARD increases with age and is higher in women than men, show data from a real-world study among people with rheumatic diseases.
Federico Díaz-González (Unidad de Investigación SER, Madrid, Spain) and co-investigators also identified a number of other patient- and treatment-related factors associated with the incidence of a first AE in the 2483 patients they studied.
The individuals from the BIOBADASER III registry had rheumatoid arthritis (RA; 45.3%), psoriatic arthritis (PsA; 27.4%), or ankylosing spondylitis (AS; 27.3%) and initiated a first biologic between 2000 and 2018.
Methotrexate use ranged from 41.8% to 60.0% depending on age but did not differ significantly between those classified as young (<25 years; n=63), adult (25–64 years; n=2127), elderly (65–75 years; n=237), or very elderly (>75 years; n=56) at the start of biologic treatment.
By contrast, corticosteroid use increased significantly with age, from 27.8% among the young cohort to 71.7% in the very elderly cohort.
As reported in Arthritis Research & Therapy, the probability of suffering a first AE was significantly higher among the elderly and very elderly participants relative to the adults, at incidence rate ratios (IRRs) of 1.42 and 1.89, respectively, after adjustment for potential confounders.
Other factors significantly associated with increased incidence of a first AE included female sex (IRR=1.43), methotrexate use (IRR=1.40), current or past smoking (IRR=1.31), use of other DMARDs (IRR=1.29), and comorbidity (IRR=1.14).
When the data were analyzed by disease type, the team found that elderly and very elderly patients with RA, and very elderly patients with PsA, were significantly more likely than adults to experience an AE, at IRRs of 1.55, 1.76, and 4.40, respectively, but there was no difference in risk among the individuals with AS.
The researchers also note that “[t]he time period until the appearance of a first AE was significantly longer in younger patients than in the adult, elderly, and very elderly groups.”
And when they looked for risk factors associated with AEs, very elderly age (hazard ratio [HR]=1.50), female sex (HR=1.42), methotrexate use (HR=1.21), smoking (HR=1.16), and comorbidity (HR=1.13) were all significant.
Díaz-González et al conclude: “Age at starting biological therapy is a key factor that seems to explain the appearance of a first AE in rheumatic patients.”
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