The association between age and adverse events due to biologic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis: A retrospective cohort study

Abstract

We examined whether the age of patients with rheumatoid arthritis was associated with adverse events (AEs) caused by biologic disease-modifying antirheumatic drugs (bDMARDs). Patients with rheumatoid arthritis using bDMARDs from Showa University Hospital, Showa University Northern Yokohama Hospital, and Showa University Koto Toyosu Hospital from January 2005 to December 2017 were eligible for this retrospective cohort study. The maximum observation period was determined to be 1 year. Outcomes in patients older and younger than 75 years were compared. The primary outcome was the rate of drug discontinuation because of AEs caused by bDMARDs. Univariate and multivariate analyses were performed using Pearson's chi-squared test and logistic regression analysis, respectively. A total of 416 patients were enrolled; median (interquartile range [IQR]): 60.0 (44.3 - 71.0) years and 84.6% women; patients ≥ 75 years were 67/416 (16.1%). The rates of drug discontinuation because of AEs caused by bDMARDs were 10.5% (7/67) in patients 75 years and older and 10.9% (38/349) in those younger than 75 years (relative risk 0.95, 95% confidential interval 0.45-2.24). In logistic regression analysis adjusted for covariates, the rate of drug discontinuation showed no significant difference between the patients ≥ 75 years and the those<75 years (adjusted odds ratio 0.70, 95% confidential interval 0.29-1.75, P=.45). The rate of drug discontinuation because of AEs caused by bDMARDs was not significantly different between patients 75 years and older and patients younger than 75 years. Abbreviations: AEs = adverse events, bDMARDs = biologic disease-modifying antirheumatic drugs, csDMARD = concomitant conventional synthetic disease-modifying anti-rheumatic drug, CI = confidential interval, CKD = chronic kidney disease, DAS28 ESR = 28-joint Disease Activity Score, erythrocyte sedimentation rate, DM = diabetes mellitus, HAQ-DI = Health Assessment Questionnaire-Disability Index, ILD = interstitial lung disease, IQR = interquartile range, PSL = prednisolone, RA = rheumatoid arthritis, TNF = tumor necrosis factor.