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  1. Y. Mochida1,
  2. K. Harigane1,
  3. T. Shimazaki1,
  4. Y. Inaba2,
  5. A. Nagaoka2
  1. 1Yokohama City University Medical Center, Center for Rheumatic Diseases, Yokohama, Japan
  2. 2Yokohama City University, Department of Orthopaedic Surgery, Yokohama, Japan


Background: Iguratimod (IGU) was started development as new non-steroidal anti-inflammatory drugs (NSAIDs), but it was changed for development as disease modifying antirheumatic drugs (DMARDs) because it showed suppression of inflammatory cytokine and inflammatory parameter which was not to be found in existing NSAIDs in the early stage of pharmacological study of drug efficacy. Although the clinical efficacy and the safety of IGU were already reported, the efficacy for elderly cases was not sufficiently analyzed.

Objectives: In this study, we compared the efficacy of IGU in elderly group with the non-elderly group.

Methods: 190 patients who were able to continuously administer IGU more than three months was included. Cases were divided into two groups. Group A (75 years or older) includes 57 patients, and Group B (younger than 75 years) includes 133 patients. The patients background, the use of methotrexate (MTX) and glucocorticoid, the change of serum CRP, and the DAS28-ESR (before, 6, 12, and 24 months) as an evaluation of the disease activity were compared between two groups. The study protocol was approved by our institutional review board. All the patients were required to give written informed consent.

Results: The average age at the beginning of IGU was 79.9±4.1 years old in Group A, and 59.9±10.6 years old in Group B. The average disease duration was 14.8±16.5 year in Group A and 8.5±10.6 year in Group B (p<0.01). Although the rate of concomitant use of MTX was significantly lower in Group A (Group A; 28.1%, Group B; 56.4%), the averaged dose of MTX did not show difference between groups (7.0 and 8.4 mg/week, respectively). Group A showed significantly higher rate of concomitant use of glucocorticoid (56.1%, and 36.1%, respectively), but the averaged dose of glucocorticoid did not show a difference between groups (4.3 and 3.6mg/day, respectively). Similarly, the rate of concomitant use of NSAIDs did not have a difference in two groups. Group A showed significantly higher serum CRP at the beginning of the IGU (Group A; 2.0 mg/dl, Group B; 1.2 mg/dl), but there was no difference after six months. In both groups, serum CRP was significantly decreased when compared at the beginning of IGU. After six months of IGU administration, both groups showed good clinical performance with DAS28-ESR, more than 60% of the cases showed remission or low disease activity. No difference of DAS28-ESR scores between two groups was observed after six months.

Conclusion: From the results of this study, the efficacy of IGU for elderly patients was confirmed and did not show differences with non-elderly people. IGU is an inexpensive drug with enough efficacy and thought to be possible substitute for cases with insufficient reaction with other DMARDs.

References: [1]Nozaki Y, et al. Modern Rheumatology 1439-7595, 2019.

[2]Yoshikawa A, et al. Mod Rheumatol 28: 227-234, 2018.

Disclosure of Interests: None declared

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