Background Treatment of rheumatoid arthritis (RA) has become markedly improved with the advent of methotrexate (MTX) and biologics. However, the percentage of RA patients aged 70 years and older receiving biologics and/or MTX is low and the mean MTX dose is also low due to frequent complications. Despite this, the use of corticosteroids is frequent among these patients. Dose reduction and discontinuation of steroids by controlling disease activity with appropriate use of antirheumatic agents are important. The clinical efficacy and safety of tofacitinib (TOF) in elderly patients remain to be clarified.

Objectives To assess the clinical efficacy and safety of TOF therapy in RA patients aged 70 years and older.

Methods Of the RA patients receiving TOF therapy introduced at our clinic, those who began therapy at the age of 70 years and older and could be followed up for at least 24 weeks were assessed retrospectively for changes in DAS28-ESR and DAS28-CRP scores, matrix metalloproteinase 3 (MMP-3) level, and laboratory test data over time. Changes in joint ultrasound (US) findings over time were also evaluated.

Results Seventeen patients aged 70 years and older who began TOF therapy in April 2014, with available pertinent data covering 24 weeks or longer, were included. TOF therapy was started at a dose of 5 mg once a day in all of the elderly patients considering their depressed physiological functions. Their mean age was 78.5 years; disease duration, 7.9 years; concomitant use of MTX, 58.8%; mean MTX dose, 7.0 mg/week; and concomitant use of corticosteroids, 64.7%. Analysis of data obtained from baseline (start of TOF therapy) to week 24 of TOF therapy revealed significant decreases in DAS28-ESR score (4.18→2.84), DAS28-CRP score (3.43→2.40), and MMP-3 level (157.9→102.4 ng/mL).

Eleven patients (182 joints) who were followed at least twice by US examination of swollen joints were evaluated. Changes in articular US findings over time did not necessarily coincide with the symptoms.

Adverse events were noted in 6 patients (herpes zoster in 2, cerebral infarction in 1, erythema in 1, low-grade fever in 1, and common cold in 1). No abnormal laboratory test value was of clinical concern.

Conclusions The present data demonstrated the relatively high efficacy of TOF therapy for RA in the patients aged 70 years and older. Even elderly patients may be indicated for active TOF therapy as needed. Cautious observation of the clinical progress would be necessary owing to the reportedly high risk of adverse events¹.

Changes in US findings of the joints over time were not necessarily consistent with the symptoms. Residual lesions on power Doppler US were evident even in the absence of arthralgia, the so-called silent synovitis status. In the TOF-treated patients, silent synovitis was demonstrated on joint US. TOF therapy seems to have a high potential efficacy as an oral biologic for RA.

References

1. Arthritis Rheum 2013; 65(Suppl 10):S994-5; Abstract 2331

Disclosure of Interest None declared