Biologic use lower in RA patients who are older, with more comorbidities
Initiation of biologic therapy is less frequent among patients with rheumatoid arthritis (RA) who are older, nonwhite and have more comorbidities, according to a recent study. Biologics may be avoided in older and sicker patients due to safety concerns, but glucocorticoid use is similar regardless of age and more common in patients with comorbidities, with implications for patient outcomes.
Methotrexate (MTX) was initiated in 17,415 patients, among whom 3,262 received biologic therapy within 2 years (2-year incidence, 20.6 percent). Adjusted analyses showed a substantially lower use of biologics in older patients (for patients ≥80 vs <50 years: adjusted hazard ratio [aHR], 0.20; 95 percent CI, 0.16–0.26) and those with more comorbidities (for Charlson score ≥3 vs <3: aHR, 0.79; 0.72–0.87).
Biologic use was also less frequent among patients with heart failure (aHR, 0.68; 0.54–0.84), cancer (aHR, 0.78; 0.66–0.92) or who were nonwhite (aHR, 0.79; 0.72–0.87). On the other hand, baseline and persistent glucocorticoid use were similar across age groups and more frequent in patients with higher comorbidities.
The investigators identified RA patients receiving a first-ever prescription of MTX, requiring ≥6 months of baseline data, using national US Veteran’s Affairs databases 2005–2016. They examined predictors of biologic therapy initiation within 2 years of initiating MTX and factors associated with baseline and persistent glucocorticoid use at 6–12 months using multivariable models.
“Biologic therapies can improve disease control for patients with RA but may be both overused and underused,” the investigators said.