Objective: To investigate the influence of age on the effectiveness and tolerance of anti-TNFα therapy in a prospective observational cohort of RA patients during the first year of anti-TNFα treatment.
Methods: In total, 730 patients of the DREAM (Dutch Rheumatoid Arthritis Monitoring) register were categorized into three groups according to their age at the initiation of anti-TNFα therapy (<45 years, 45-65 years and >65 years). Effectiveness of anti-TNFα therapy was primarily assessed by longitudinal analysis of the DAS28 during the first 12 months of treatment. EULAR criteria for clinical response and remission, the improvement in functional capacity (HAQ) and the health-related quality of life (SF-36), tolerance of anti-TNFα therapy and treatment decisions after the cessation of anti-TNFα therapy were also analyzed.
Results: Improvement in disease activity and physical functioning was significantly less in elderly patients, correcting for relevant confounders. Elderly patients reached the EULAR categories of good-responders and remission less often than younger patients. Drug survival, co-medication use and tolerance were comparable between the 3 age groups.
Conclusion: Anti-TNFα therapy appeared to be less effective in elderly compared to younger RA patients, based on smaller improvements in DAS28 and HAQ and lower percentages of good response and clinical remission reached during the first 12 months of treatment.
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