Certain Aspects of ACTH and Cortisone Therapy in Older Patients with Rheumatoid Arthritis

Background Biological disease-modifying antirheumatic drugs (bDMARDs) are recommended for rheumatoid arthritis (RA), but older patients reportedly experience more adverse events (AEs) and show variable treatment response. The objective of this study was to evaluate AEs and effectiveness of bDMARDs in a cohort of older patients. Methods AE and treatment effectiveness (based on DAS28 scores) data from a prospective provincial pharmacovigilance program for the years 2006–2009 in patients 55–64, 65–74, and 75+ years of age were compared. An intention to treat analysis with chisquare and unpaired t-testing for significance was performed. Results There were a total of 333 patients (156 were aged 55–64, 125 were 65–74, 52 were 75+). Those 75+ had higher disease activity and worse functional status at baseline. Among those 75+, AEs with bDMARDs were more common and likely to lead to discontinuation of therapy, be graded as severe, and classified as infectious (p < .05). Remission rate among those 75+ was significantly higher than patients 65–74. Etanercept was the most commonly used drug in all age groups. Conclusion Patients 75+ treated with bDMARDs are at a significantly greater risk of AEs, including infectious ones. The higher remission found in the oldest age group warrants further study.

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BAFF Predicts Immunogenicity in Older Patients With Rheumatoid Arthritis Treated With TNF Inhibitors

10.21203/rs.3.rs-74233/v1 ◽

2020 ◽

Author(s):

Borja Hernández-Breijo ◽

Victoria Navarro-Compán ◽

Chamaida Plasencia-Rodríguez ◽

Ioannis Parodis ◽

Johanna E. Gehin ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Older Patients ◽

Operating Characteristic ◽

Certolizumab Pegol ◽

Positive Likelihood Ratio ◽

Characteristic Analysis ◽

Serum Samples ◽

Chi Square ◽

Baseline Serum ◽

Logistic Regression Models

Abstract Background: Immunogenicity related to treatment with TNF inhibitors (TNFi) is one of the causes for the decreased attainment of clinical response in patients with rheumatoid arthritis (RA). The B-cell activating factor (BAFF) may be playing a role in the development of immunogenicity. The objective of this study was to analyse the association of baseline concentration of serum BAFF with immunogenicity after 6 months of TNFi treatment.Methods: A total of 139 patients with RA starting a TNFi (infliximab, adalimumab, certolizumab pegol or golimumab) were followed-up for 6 months. Serum samples were obtained at baseline and at 6 months and anti-drug antibody (ADA) and BAFF concentrations were measured. Logistic regression models were employed in order to analyse the association between BAFF concentrations and immunogenicity. Receiver operating characteristic analysis was performed to determine the BAFF concentrations with a greater likelihood of showing immunogenicity association.Results: At 6 months, 39 patients (28%) developed ADA. A significant interaction between the age and baseline BAFF concentration was found for the development of ADA (Wald chi-square value=5.30; p=0.02); therefore, subsequent results were stratified according to mean age (≤/>55 years). Baseline serum BAFF concentration was independently associated with ADA development only in patients over 55 years (OR=1.55; 95% CI: 1.03-2.12). Baseline serum BAFF≥1034pg/mL predicted the presence of ADA at 6 months (positive likelihood ratio=3.7).Conclusions: Our results suggest that the association of BAFF concentration and immunogenicity depends on the patient’s age. Baseline serum BAFF concentration predicts the presence of ADA within 6 months of TNFi therapy in older patients with RA.

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Gender- and Age-related Differences of Statin Use on Incident Dementia in Patients with Rheumatoid Arthritis: A Nationwide Population-based Cohort Study

10.21203/rs.3.rs-249981/v1 ◽

2021 ◽

Author(s):

Tsung-Kun Lin ◽

Jing-Yang Huang ◽

Lung-Fa Pan ◽

Gwo-Ping Jong

Keyword(s):

Rheumatoid Arthritis ◽

Cohort Study ◽

Subgroup Analysis ◽

Older Patients ◽

Cox Regression ◽

Population Based ◽

Age Related ◽

Hazard Ratios ◽

Gender And Age ◽

New Onset

Abstract Background: Some observational studies have found a significant association between the use of statin and a reduced risk of dementia. However, the results of these studies are unclear in patients with rheumatoid arthritis (RA). This study is to determine the association between the use of statins and the incidence of dementia according to sex and age-related differences in patients with RA.Methods: We conducted a nationwide retrospective cohort study using the Taiwan Health Insurance Review and Assessment Service database (2003–2016). The primary outcome assessed was the risk of dementia by estimating hazard ratios (HRs) and 95% confidence intervals (CIs). Multiple Cox regression was used to estimate the adjusted hazard ratio of new-onset dementia. Subgroup analysis was also conducted.Results: Among the 264,036 eligible patients with RA aged > 40 years, statin users were compared with non-statin users by propensity score matching at a ratio of 1:1 (25,764 in each group). However, no association was found between the use of statins and the risk of new-onset dementia (NOD) in patients with RA (HR: 1.01; 95%CI: 0.97–1.06). The subgroup analysis identified the use of statin as having a protective effect against developing NOD in male and older patients.Conclusion: There is no association between the use of statin and the risk of NOD in patients with RA, but these parameters are influenced by gender and age. The decreased risk of NOD in patients with RA was greater among male and older patients. The use of statin in older male patients with RA for the prevention of dementia may be needed in clinical practice.

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Younger Patients With Rheumatoid Arthritis Are as Dependent in Activities of Daily Living as Their Older Counterparts

10.21203/rs.3.rs-95016/v1 ◽

2020 ◽

Author(s):

Ayse Nur Tufan ◽

Fatih Tufan ◽

Mustafa Ferhat Oksuz ◽

Selime Ermurat ◽

Belkis Nihan Coskun ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Activities Of Daily Living ◽

Daily Living ◽

Older Patients ◽

Antidepressant Treatment ◽

Female Gender ◽

Depression Score ◽

University Hospital ◽

Cross Sectional ◽

Instrumental Activities

Abstract Background: Rheumatoid arthritis is an important cause of disability and dependency in older adults. We aimed to assess dependency in activities of daily living in younger and older patients with rheumatoid arthritis and to seek factors underlying dependency in activities of daily living.Methods: In this cross-sectional study, we assessed dependency in basic and instrumental activities of daily living; disease activity; quality of life; depression; anxiety; and fatigue in the rheumatology clinic of a university hospital. Univariate analyses and a logistic regression analysis were performed to determine factors associated with dependency.Results: We enrolled 76 patients with a mean age of 57±11.1 (range 31-78). The rate of dependency in instrumental activities of daily living was high in younger (56.1%) and older (51.4%) patients. The rate of dependency in basic activities of daily living was 14.6% in younger and 14.3% in older patients. A higher depression score and female gender had significant associations with dependency in instrumental activities of daily living.Conclusion: The rate of dependency in basic and instrumental activities of daily living is high in younger and older patients with rheumatoid arthritis. Depression seems to be an independent and important factor underlying dependency. Further studies are needed to investigate the mechanisms of this association and test the effect of antidepressant treatment on dependency in rheumatoid arthritis.

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