Takahiko Sugihara1, Tatsuro Ishizaki2, Tadashi Hosoya3, Shoko Iga2, Waka Yokoyama4, Fumio Hirano4, Nobuyuki Miyasaka2, Masayoshi Harigai3. 1. Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Department of Medicine and Rheumatology and Department of Pharmacovigilance, Tokyo Medical and Dental University, Tokyo, Japan takahiko_sugihara@tmghig.jp. 2. Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Department of Medicine and Rheumatology and Department of Pharmacovigilance, Tokyo Medical and Dental University, Tokyo, Japan. 3. Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Department of Medicine and Rheumatology and Department of Pharmacovigilance, Tokyo Medical and Dental University, Tokyo, Japan Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Department of Medicine and Rheumatology and Department of Pharmacovigilance, Tokyo Medical and Dental University, Tokyo, Japan. 4. Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Department of Medicine and Rheumatology and Department of Pharmacovigilance, Tokyo Medical and Dental University, Tokyo, Japan Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Department of Medicine and Rheumatology and Department of Pharmacovigilance, Tokyo Medical and Dental University, Tokyo, Japan Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Department of Medicine and Rheumatology and Department of Pharmacovigilance, Tokyo Medical and Dental University, Tokyo, Japan.
Abstract
OBJECTIVE: The aim of this study was to evaluate structural damage and physical disability in patients with elderly-onset RA (EORA) who were treated in clinical practice with a therapeutic strategy targeting low disease activity (LDA). METHODS: Data from 151 MTX-naive patients (mean age 74.9 years) with EORA from a prospective, monocentric registry were analysed. Treatment was adjusted every 3 months targeting LDA [28-joint DAS using ESR (DAS28-ESR) <3.2]. Treatment was initiated with non-biologic DMARDs (nbDMARDs), followed by TNF inhibitors (TNFis) or tocilizumab. The primary outcome was change from week 0 to week 52 in the modified total Sharp score (ΔmTSS). Secondary outcomes were derived from the HAQ Disability Index (HAQ-DI) and DAS28 at week 52. Predictors of clinically relevant radiographic progression [CRRP; ΔmTSS/year more than the smallest detectable change (2.1 points)] were examined using multivariate logistic regression models. RESULTS: Adherence to the treat-to-target strategy was observed in 83.4% of the 151 patients at week 24 and in 75.5% at week 52. At week 52, 67.6% of the patients were receiving a nbDMARD alone, 31.0% a TNFi with or without MTX and 1.4% tocilizumab. At week 52, structural remission (ΔmTSS/yr ≤0.5) was achieved in 49.7% of the patients, functional remission (HAQ-DI ≤0.5) in 63.4% and LDA in 51.0%. Clinical responses at weeks 12 and 24 were significant independent predictors of CRRP. Cumulative disease activity during the first 12 weeks predicted CRRP with a C-statistic of 0.888. CONCLUSION: Achieving structural remission, functional remission and LDA in clinical practice in EORA patients are realistic goals. Our results indicate significant benefits for a therapeutic strategy targeting LDA for EORA patients in clinical practice.
OBJECTIVE: The aim of this study was to evaluate structural damage and physical disability in patients with elderly-onset RA (EORA) who were treated in clinical practice with a therapeutic strategy targeting low disease activity (LDA). METHODS: Data from 151 MTX-naive patients (mean age 74.9 years) with EORA from a prospective, monocentric registry were analysed. Treatment was adjusted every 3 months targeting LDA [28-joint DAS using ESR (DAS28-ESR) <3.2]. Treatment was initiated with non-biologic DMARDs (nbDMARDs), followed by TNF inhibitors (TNFis) or tocilizumab. The primary outcome was change from week 0 to week 52 in the modified total Sharp score (ΔmTSS). Secondary outcomes were derived from the HAQ Disability Index (HAQ-DI) and DAS28 at week 52. Predictors of clinically relevant radiographic progression [CRRP; ΔmTSS/year more than the smallest detectable change (2.1 points)] were examined using multivariate logistic regression models. RESULTS: Adherence to the treat-to-target strategy was observed in 83.4% of the 151 patients at week 24 and in 75.5% at week 52. At week 52, 67.6% of the patients were receiving a nbDMARD alone, 31.0% a TNFi with or without MTX and 1.4% tocilizumab. At week 52, structural remission (ΔmTSS/yr ≤0.5) was achieved in 49.7% of the patients, functional remission (HAQ-DI ≤0.5) in 63.4% and LDA in 51.0%. Clinical responses at weeks 12 and 24 were significant independent predictors of CRRP. Cumulative disease activity during the first 12 weeks predicted CRRP with a C-statistic of 0.888. CONCLUSION: Achieving structural remission, functional remission and LDA in clinical practice in EORA patients are realistic goals. Our results indicate significant benefits for a therapeutic strategy targeting LDA for EORA patients in clinical practice.