Clément Lahaye1, Martin Soubrier2, Aurélien Mulliez3, Thomas Bardin4, Alain Cantagrel5, Bernard Combe6, Maxime Dougados7, René-Marc Flipo8, Xavier Le Loët9, Thierry Shaeverbeke10, Philippe Ravaud11, Xavier Mariette12, Jacques-Eric Gottenberg13. 1. Department of Internal Medicine, Hôpital Estaing. 2. Department of Rheumatology, Hôpital Gabriel Montpied msoubrier@chu-clermontferrand.fr. 3. Biostatistics Unit, La Délégation Recherche Clinique et Innovation, CHU de Clermont-Ferrand, Clermont-Ferrand. 4. Department of Rheumatology, Hôpital Lariboisière, Assistance Publique, Hôpitaux de Paris, Paris. 5. Department of Rheumatology, Purpan Hospital, Toulouse. 6. Department of Rheumatology, Hôpital Lapeyronie, Montpellier, Université Montpellier I, Montpellier. 7. Department of Rheumatology, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris INSERM (U1153), Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris. 8. Department of Rheumatology, Lille Teaching Hospital, Lille. 9. Department of Rheumatology, Rouen Teaching Hospital, Rouen. 10. Department of Rheumatology, Bordeaux Teaching Hospital, Bordeaux. 11. Centre d'Epidémiologie Clinique, Hotel Dieu, Assistance Publique, Hôpitaux de Paris. 12. Department of Rheumatology, Hôpital Bicêtre, Assistance Publique, Hôpitaux de Paris and. 13. Department of Rheumatology, Strasbourg Teaching Hospital, Strasbourg, France.
Abstract
OBJECTIVE: To study the effect of age on the risk-benefit balance of abatacept in RA. METHODS: Data from the French orencia and RA registry, including a 2-year follow-up, were used to compare the effectiveness and safety of abatacept according to age. RESULTS: Among the 1017 patients, 103 were very elderly (⩾75 years), 215 elderly (65-74), 406 intermediate aged (50-64) and 293 very young (<50). At baseline, elderly and very elderly patients had longer disease duration, higher CRP levels and higher disease activity. These age groups showed a lower incidence of previous anti-TNF therapy and less common concomitant use of DMARDs, but a similar use of corticosteroid therapy. After adjusting for disease duration, RF/ACPA positivity, use of DMARDs or corticosteroids and previous anti-TNF treatment, the EULAR response (good or moderate) and the remission rate were not significantly different between the four age groups. At 6 months, the very elderly had a significantly lower likelihood of a good response than the very young (odds ratio = 0.15, 95% CI: 0.03, 0.68). The decrease in DAS28-ESR over the 24-month follow-up period did not differ by age. Increasing age was associated with a higher rate of discontinuation for adverse events, especially severe infections (per 100 patient-years: 1.73 in very young, 4.65 in intermediates, 5.90 in elderly, 10.38 in very elderly; P < 0.001). CONCLUSION: The effectiveness of abatacept is not affected by age, but the increased rate of side effects, especially infections, in the elderly must be taken into account.
OBJECTIVE: To study the effect of age on the risk-benefit balance of abatacept in RA. METHODS: Data from the French orencia and RA registry, including a 2-year follow-up, were used to compare the effectiveness and safety of abatacept according to age. RESULTS: Among the 1017 patients, 103 were very elderly (⩾75 years), 215 elderly (65-74), 406 intermediate aged (50-64) and 293 very young (<50). At baseline, elderly and very elderly patients had longer disease duration, higher CRP levels and higher disease activity. These age groups showed a lower incidence of previous anti-TNF therapy and less common concomitant use of DMARDs, but a similar use of corticosteroid therapy. After adjusting for disease duration, RF/ACPA positivity, use of DMARDs or corticosteroids and previous anti-TNF treatment, the EULAR response (good or moderate) and the remission rate were not significantly different between the four age groups. At 6 months, the very elderly had a significantly lower likelihood of a good response than the very young (odds ratio = 0.15, 95% CI: 0.03, 0.68). The decrease in DAS28-ESR over the 24-month follow-up period did not differ by age. Increasing age was associated with a higher rate of discontinuation for adverse events, especially severe infections (per 100 patient-years: 1.73 in very young, 4.65 in intermediates, 5.90 in elderly, 10.38 in very elderly; P < 0.001). CONCLUSION: The effectiveness of abatacept is not affected by age, but the increased rate of side effects, especially infections, in the elderly must be taken into account.