Efficacy and safety of targeted strategy for treating rheumatoid arthritis patients aged 75 years or older

Abstract

The efficacy and safety of targeted treatment for elderly patients with rheumatoid arthritis (RA) was considered. Patients with RA who met the ACR/EULAR 2010 classification criteria and were treated consecutively for > 3 years, were recruited and classified into three age groups with 10-year increments from 65 years. Treatment protocol that aims to achieve clinical remission within 6 months was commonly adopted. The salient features are the rapid increase in dosages of conventional synthetic anti-rheumatic drugs (csDMARDs) and the administration of need-based concomitant biologic/targeted synthetic drugs and/or glucocorticoid steroid, and immediate tapering of glucocorticoid steroid and csDMARDs is required on attaining clinical remission. Disease activity score and other clinical indices specific for RA treatment, and the prevalence of adverse events were compared between the groups. The numbers of patients in the groups of the < 65 years, 65-74 years, and ≥ 75 years were 269, 155, and 152. No significant difference was observed between any pairs of groups with respect to disease activity; stable course after achievement of minimum disease activity was observed in all groups. However, the prevalence of adverse events, especially serious infection, in the oldest group was higher than that in the younger groups, which was likely attributable to the higher frequency of administration of glucocorticoid steroid after minimum disease activity obtained and higher prevalence of cardiovascular comorbidities. Targeted treatment is feasible even for patients aged ≥ 75. However, glucocorticoid steroid administration is considered as a risk of adverse events and should be tapered immediately.