Drug efficacy and safety of biologics and Janus kinase inhibitors in elderly patients with rheumatoid arthritis

2021 ◽  
Author(s):  
Kosuke Ebina
Keyword(s):  
Rheumatoid Arthritis ◽  
Adverse Events ◽  
Elderly Patients ◽  
Kinase Inhibitors ◽  
Janus Kinase ◽  
Treatment Recommendation ◽  
Efficacy And Safety ◽  
Old Patients ◽  
Janus Kinase Inhibitors ◽  
Increased Risk

ABSTRACT Elderly patients with rheumatoid arthritis (RA) are frequently associated with higher disease activity and impaired physical function, although they show intolerance for conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), such as methotrexate, because of their comorbidities. However, the present treatment recommendation based on randomized controlled trials is not distinguished by age or comorbidities. Therefore, this review aimed to investigate the efficacy and safety of biological DMARDs (bDMARDs) and Janus kinase inhibitors (JAKi) in elderly patients. Present bDMARDs, including tumor necrosis factor inhibitors (TNFi), cytotoxic T lymphocyte-associated antigen-4-immunoglobulin (abatacept), interleukin (IL)-6 receptor antibody (tocilizumab and salirumab), and anti-CD20 antibody (rituximab), may be similarly or slightly less effective or safe in elderly patients compared with younger patients. Oral glucocorticoid use, prolonged disease duration, and very old patients appear to be associated with an increased risk of adverse events, such as serious infection. Some recent cohort studies demonstrated that non-TNFi showed better retention than TNFi in elderly patients. Both TNFi and non-TNFi agents may not strongly influence the risk of adverse events such as cardiovascular events and malignancy in elderly patients. Regarding JAKi, the efficacy appears to be similar, although the safety (particularly for serious infections, including herpes zoster) may be attenuated by aging.

scholarly journals Efficacy and Safety of Janus Kinase Inhibitors in Type I Interferon-Mediated Monogenic Autoinflammatory Disorders: A Scoping Review

2021 ◽  
Author(s):  
Pedro Jesús Gómez-Arias ◽  
Francisco Gómez-García ◽  
Jorge Hernández-Parada ◽  
Ana María Montilla-López ◽  
Juan Ruano ◽  
...  
Keyword(s):  
Scoping Review ◽  
Kinase Inhibitors ◽  
Type I Interferon ◽  
Janus Kinase ◽  
Type I ◽  
Efficacy And Safety ◽  
Autoinflammatory Disorders ◽  
Janus Kinase Inhibitors

Safety of Biologic Agents in Elderly Patients with Rheumatoid Arthritis

2016 ◽  
Vol 43 (11) ◽  
pp. 1984-1988 ◽  
Author(s):  
Atsuko Murota ◽  
Yuko Kaneko ◽  
Kunihiro Yamaoka ◽  
Tsutomu Takeuchi
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Adverse Events ◽  
Elderly Patients ◽  
Young Patients ◽  
Pulmonary Complications ◽  
Biologic Agents ◽  
Treatment Withdrawal ◽  
Old Patients ◽  
Independent Risk Factors

Objective.To clarify the safety of biologics in elderly patients with rheumatoid arthritis.Methods.Biologics were analyzed for safety in relation to age in 309 patients.Results.Young (< 65 yrs old, n = 174), elderly (65–74 yrs old, n = 86), and older elderly patients (≥ 75 yrs old, n = 49) were enrolled. Although the incidence of adverse events causing treatment withdrawal was significantly higher in elderly and old elderly compared with young patients, no difference was found between elderly and older elderly patients. Pulmonary complications were independent risk factors.Conclusion.Old patients require special attention, although the safety of biologics in those ≥ 75 years old and 65–74 was comparable.

scholarly journals Factors Affecting Drug Retention of Janus kinase Inhibitors in Patients with Rheumatoid Arthritis: The ANSWER Cohort Study

2021 ◽  
Author(s):  
Kosuke Ebina ◽  
Toru Hirano ◽  
Yuichi Maeda ◽  
Wataru Yamamoto ◽  
Motomu Hashimoto ◽  
...  
Keyword(s):  
Adverse Events ◽  
Kinase Inhibitors ◽  
Retention Rate ◽  
Janus Kinase ◽  
Tnf Inhibitor ◽  
Janus Kinase Inhibitors ◽  
Factors Affecting ◽  
Female Sex ◽  
Drug Retention ◽  
Prior Use

Abstract Background: This multi-center, retrospective study aimed to clarify the factors affecting drug retention of the Janus kinase inhibitors (JAKi) baricitinib (BAR) and tofacitinib (TOF) in patients with RA.Methods: Patients were included as follows: females, 80.6%; age, 60.5 years; DAS28-ESR, 4.3; treated with either BAR (n = 166) or TOF (n = 185) and concomitant glucocorticoid (prednisolone [PSL] equivalent) 5.3 mg/day (46.7%) or methotrexate (MTX) 8.9 mg/week (60.7%); bDMARDs- or JAKi-switched cases (76.6%). The reasons for drug discontinuation were classified into four major categories: lack of effectiveness, toxic adverse events, non-toxic reasons and remission. The drug retention rate was estimated at 24 months using the Kaplan–Meier method and adjusted for potential confounders using multivariate Cox proportional hazards modelling.Results: Adjusted discontinuation rates for the corresponding reasons were as follows: lack of effectiveness (22.3%), toxic adverse events (13.3%), non-toxic reasons (7.2%) and remission (0.0%). Prior use of anti-interleukin-6 receptor antibody (aIL-6R) was significantly associated with discontinuation due to lack of effectiveness (P = 0.021). Ageing (P = 0.015), usage of PSL ≥5 mg/day (P = 0.017) and female sex (P = 0.041) were significantly associated with discontinuation due to toxic adverse events. Factors not associated with treatment discontinuation were: number of prior bDMARDs or JAKi, concomitant MTX usage, different JAKi and prior use of TNF inhibitor, CTLA4-Ig or other JAKi.Conclusions: Prior use of aIL-6R was associated with discontinuation due to lack of effectiveness, while ageing (≥75 years), PSL usage ≥5 mg/day, and female sex were associated with discontinuation due to toxic adverse events.

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