Optimal biologic therapy for RA varies by age
medwireNews: The outcomes of patients with rheumatoid arthritis (RA) could be improved by using the biologic DMARD option most appropriate to the age group, say Japanese researchers who assessed retention rates by age.
Yoshiya Tanaka (University of Occupational and Environmental Health, Kitakyushu) and colleagues say that “the effectiveness and safety of [tocilizumab] were maximal in patients aged <75 years and that the patients aged ≥75 years might be suitable candidates for [tocilizumab] and [abatacept] therapy.”
They analyzed data pertaining to 1362 patients with RA enrolled in the Japanese FIRST registry, who were prescribed tocilizumab, abatacept, or a tumor necrosis factor (TNF) inhibitor following an inadequate response to a conventional synthetic DMARD.
Tocilizumab was associated with a significantly higher 3-year retention rate than abatacept and TNF inhibitors, at 65% versus 51% and 43%, respectively, after adjustment for inverse probability of treatment weighting based on generalized propensity score to account for patient selection bias and confounding by indication.
When the researchers looked at the rates according to three age groups – younger than 65 years, 65–74 years, and 75 years or older – the 3-year retention rates among the 695 patients younger than 65 years were also significantly higher with tocilizumab than with abatacept and TNF inhibitors, at 69% versus 47% and 43%, respectively.
But Tanaka et al note that “retention rates of [abatacept] increased with age.” Among the 402 patients aged between 65 and 74 years, the 3-year retention rate with tocilizumab was numerically higher than that with abatacept (60 vs 53%), but not significantly so. It did remain significantly higher than the retention rate with TNF inhibitors (44%), however.
They add that this similarity between abatacept and tocilizumab in patients 65 years and older was “even more pronounced” in the 265 patients who were at least 75 years old, with 3-year retention rates with tocilizumab and abatacept of 58% and 63% versus 38% with TNF inhibitors.
The retention rate associated with abatacept was significantly higher than that with TNF inhibitors, but due to a small sample size, no statistical analysis was performed for tocilizumab, the researchers explain.
Overall, similar results were observed when patients who discontinued due to remission were excluded from the analysis, according to Tanaka and team.
They point out in Arthritis Research & Therapy that abatacept may be a more appealing option in older patients because it is associated with fewer adverse events. In the current study, the rate of discontinuation due to adverse events was lowest with abatacept across all age groups. In addition to this, improvement in CDAI scores was comparable across the three treatments in the oldest patient group.
TNF inhibitor treatment was associated with the greatest improvement in CDAI, overall, and this was most pronounced in those younger than 65 years of age. It was also associated with the highest rate of discontinuation because of remission.
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