Background Biological drugs have dramatically improved the prognosis of rheumatoid arthritis (RA), especially in those with early disease. These patientsare often in younger age with fewer co-morbidities. Recent Canadian data suggests the highest incidence and prevalence of RA is in the 55-85 year old age group, often with associated co-morbidities, poly-pharmacy, and often longstanding disease.
Objectives The objective of this real world retrospective effectiveness study was to evaluate effectiveness, safety and durability of etanercept initiated in patients over the age of 65 (inclusive).
Methods This study is a retrospective analysis of all elderly RA patients, started on etanercept for at least 3 months, between Jan 2004 and Dec 2011 at a single center in Hamilton, Canada. Information was collected on demographic variables, previous and ongoing DMARDs/steroids, swollen joint counts (SJC), tender joint counts (TJC), etanercept treatment details, reason for treatment discontinuation and any reported adverse event. Efficacy was evaluated by the change in swollen and tender joint counts over a period of time after etanercept treatment. Treatment effectiveness assessed by calculating the overall drug-survival.
Results A total of 72 patients from the study period of January 2004 to December 2011 were included in the analysis. A total of 71% of the patients were female, with a mean age of 73.0±5.35 years, and 73.3% were rheumatoid factor positive. 42.6% of patients had a disease duration less than 10 years. The median drug survival was 42 months, with 60% and 50% patients respectively were still on etanercept in the age group of 65-75 and more than 75 years at the end of the study period. Significant improvement in the mean SJC (p-value <0.001) from baseline (8.45±4.81) to treatment at 3 months (4.56±3.92), at 13 months (2.56±2.84) and 23 months (1.85±2.06) was observed. Similar efficacy was observed in patients between age group of 65-80 and over 80 years. Patients with early as well as longstanding RA showed similar sustained improvement in disease activity over time. Concomitant use of DMARDs (methotrexate and leflunomide) reduced significantly (p-value<0.05) after treatment with etanercept. Common reported adverse events were injection site reaction (2.77%), lung infection (6.94%), URTI (4.16%), UTI (8.33%) and other infections (12.5%).
Conclusions As the demographics of RA changes, knowledge about RA care in the elderly population will be crucial. In this real world effectiveness study assessing RA patients over age 65, our results suggest that etanercept was an effective therapy despite the advanced age, and often long disease duration. There were also no unexpected safety concerns.
Disclosure of Interest A. Lau Grant/research support: Amgen, Roche, Speakers bureau: Amgen, Roche, A. Shah: None declared, M. Deamude: None declared, C. Mech: None declared, R. Bensen: None declared, W. Bensen: None declared