Nobunori Takahashi1, Toshihisa Kojima1, Daihei Kida2, Atsushi Kaneko2, Yuji Hirano3, Takayoshi Fujibayashi4, Yuichiro Yabe5, Hideki Takagi6, Takeshi Oguchi7, Masahiro Hanabayashi8, Takefumi Kato9, Koji Funahashi10, Masatoshi Hayashi11, Seiji Tsuboi12, Yasuhide Kanayama13, Yasumori Sobue1, Nobuyuki Asai1, Takuya Matsumoto1, Tatsuo Watanabe1, Shuji Asai1, Naoki Ishiguro1. 1. Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Japan. 2. Department of Orthopedic Surgery and Rheumatology, Nagoya Medical Center, Nagoya, Japan. 3. Department of Rheumatology, Toyohashi Municipal Hospital, Toyohashi, Japan. 4. Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan. 5. Department of Rheumatology, Tokyo Shinjuku Medical Center, Tokyo, Japan. 6. Department of Orthopedic Surgery, Nagoya Central Hospital, Nagoya, Japan. 7. Department of Orthopedic Surgery, Anjo Kosei Hospital, Anjo, Japan. 8. Department of Orthopedic Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Japan. 9. Kato Orthopedic Clinic, Okazaki, Japan. 10. Department of Orthopedic Surgery, Kariya-Toyota General Hospital, Kariya, Japan. 11. Department of Rheumatology, Nagano Red Cross Hospital, Nagano, Japan. 12. Department of Orthopedic Surgery, Shizuoka Kosei Hospital, Shizuoka, Japan. 13. Department of Orthopedic Surgery, Toyota Kosei Hospital, Toyota, Japan.
Abstract
Objective: To study the clinical effectiveness and long-term retention rate of abatacept (ABA) in elderly rheumatoid arthritis (RA) patients in daily clinical practice. Methods: A retrospective cohort study was performed using data from a multicenter registry. Our study population comprised 500 consecutive RA patients treated with ABA. We compared clinical effectiveness and ABA retention rates between the Young (≤62 years), Middle (62 to 72 years), and Elderly (≥72 years) groups. We also performed separate examinations to identify predictive factors for ABA discontinuation in those with versus those without concomitant methotrexate (MTX) treatment. Results: Mean age was 52.7 years in the Young group, 67.7 years in the Middle group, and 78.1 years in the Elderly group. No significant group-dependent differences were found in mean DAS28 score, categorical distribution of DAS28, and EULAR response rate across the 52 weeks. The ABA retention rates at three years as determined by the Kaplan-Meier method were similar in all three groups. Patient age was not a significant predictor of ABA discontinuation due to adverse events in patients with concomitant MTX; however, it was found to be a significant predictor for those who did not use MTX (Cox hazard model). Conclusion: ABA would be a reasonable treatment option for elderly RA patients from the viewpoints of both clinical effectiveness and long-term retention. However, physicians should watch carefully for any serious adverse reactions in elderly RA patients with intolerance to MTX.
Objective: To study the clinical effectiveness and long-term retention rate of abatacept (ABA) in elderly rheumatoid arthritis (RA) patients in daily clinical practice. Methods: A retrospective cohort study was performed using data from a multicenter registry. Our study population comprised 500 consecutive RApatients treated with ABA. We compared clinical effectiveness and ABA retention rates between the Young (≤62 years), Middle (62 to 72 years), and Elderly (≥72 years) groups. We also performed separate examinations to identify predictive factors for ABA discontinuation in those with versus those without concomitant methotrexate (MTX) treatment. Results: Mean age was 52.7 years in the Young group, 67.7 years in the Middle group, and 78.1 years in the Elderly group. No significant group-dependent differences were found in mean DAS28 score, categorical distribution of DAS28, and EULAR response rate across the 52 weeks. The ABA retention rates at three years as determined by the Kaplan-Meier method were similar in all three groups. Patient age was not a significant predictor of ABA discontinuation due to adverse events in patients with concomitant MTX; however, it was found to be a significant predictor for those who did not use MTX (Cox hazard model). Conclusion: ABA would be a reasonable treatment option for elderly RApatients from the viewpoints of both clinical effectiveness and long-term retention. However, physicians should watch carefully for any serious adverse reactions in elderly RApatients with intolerance to MTX.