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Biologic use lower in RA patients who are older, with more comorbidities

02 May 2019

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.

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Most Read Articles
Jairia Dela Cruz, 10 Apr 2019
Treatment with tofacitinib yields significant improvements in signs and symptoms of rheumatoid arthritis (RA) in patients from the Asia Pacific, according to data from a posthoc analysis. The drug has a safety profile consistent with global tofacitinib studies, although infections occur more frequently in Asians.
Jairia Dela Cruz, 30 Apr 2019
In rheumatoid arthritis (RA) patients in remission, increasing the dose interval of tocilizumab injection from the standard 162 mg once weekly to twice weekly may do more harm than good. Specifically, such a strategy is associated with a lower chance of remission maintenance as well as a lack of improvement in tolerability, as shown in a recent trial.
Jairia Dela Cruz, 29 Apr 2019
Physicians are likely to underestimate the severity of psoriatic arthritis (PsA) in patients who are older, show higher fatigue levels, complain of greater pain or have poorer mental health, according to a Singapore study. In contrast, overestimation of disease severity by physicians tends to occur in the presence of higher swollen joint counts.
Jairia Dela Cruz, 05 Jan 2017
Patients with early arthritis should be allowed to share in the decision making regarding the approach to treatment, with rheumatologists acting as the primary specialists, according to the 2016 update of the European League Against Rheumatism (EULAR) recommendations for early arthritis management.