SAT0131 SAFETY AND EFFECTIVENESS OF DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS (BDMARDS) IN OLDER ADULTS WITH RHEUMATOID ARTHRITIS: A RETROSPECTIVE COHORT STUDY

Abstract Background Difficult-to-treat rheumatoid arthritis (dt-RA) is an emerging concept, the definition of which has been proposed based on global consensus. This study aimed to establish an evidence-based definition of dt-RA with respect to responsiveness to newly used biologic and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs). Methods A retrospective cohort study was conducted using the FIRST registry. An inadequate response to current b/tsDMARDs was defined as clinical disease activity index (CDAI) >10 at week 22 or termination of treatment within 22 weeks due to insufficient efficacy. Cut-off values were defined according to the number of past failures to DMARDs and dose of glucocorticoid. Responsiveness to newly used b/tsDMARDs were compared with respect to above- versus below- cut-off values. Hazards of treatment cessation within 22 weeks due to adverse events were also compared using the same thresholds. Results The cut-off values associated with significant differences in responsiveness to b/tsDMARD treatment were ≥ 2 failures to conventional synthetic DMARD (csDMARD) treatment and ≥ 4 failures to b/tsDMARD treatment. Three or more failures to csDMARDs and concomitant use of glucocorticoid were significantly correlated with an increased hazard ratio of infection. Further analysis using clinical variables revealed that refractoriness to ≥ 2 previous csDMARDs was weakly associated with less improvement in ESR titre, while refractoriness to ≥ 4 previous b/tsDMARDs was associated with less improvement in HAQ. For both cut-offs, significant but weak association with GH was also observed. Conclusions We propose cut-off values of ≥ 2 failures to csDMARDs and/or ≥ 4 b/tsDMARDs to define dt-RA with respect to responsiveness to use of b/tsDMARDs.

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This is a Retrospective Cohort Study to Evaluate Patient Characteristics and Treatment Patterns Among Rheumatoid Arthritis Patients

Case Medical Research ◽

10.31525/ct1-nct04047121 ◽

2019 ◽

Author(s):

Keyword(s):

Rheumatoid Arthritis ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Patient Characteristics ◽

Treatment Patterns

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A Retrospective Cohort Study on the Risk of Serious Infections in Rheumatoid Arthritis Patients Receiving Tocilizumab

Case Medical Research ◽

10.31525/ct1-nct04115423 ◽

2019 ◽

Author(s):

Keyword(s):

Rheumatoid Arthritis ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Serious Infections

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Characteristics and Outcomes of Hip Fracture Patients Hospitalized in an Orthogeriatric Unit Versus an Orthopedic Department: A Retrospective Cohort Study

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459320986299 ◽

2021 ◽

Vol 12 ◽

pp. 215145932098629 ◽

Cited By ~ 1

Author(s):

Yulia Bugaevsky ◽

Yochai Levy ◽

Avital Hershkovitz ◽

Irena Ocheretny ◽

Adaya Nissenholtz ◽

...

Keyword(s):

Older Adults ◽

Cohort Study ◽

Hip Fracture ◽

Hip Fractures ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Functional Independence ◽

Functional Improvement ◽

Orthopedic Department ◽

Successful Recovery

Introduction: Hip fractures are a significant health risk in older adults and a major cause of morbidity, functional decline and mortality. Our aim was to compare clinical outcomes of older patients hospitalized in an ortho-geriatric (OG) unit to those hospitalized in an orthopedic department (OD) for surgical treatment of a hip fracture. Methods: A retrospective cohort study of hip fractured patients hospitalized between 2015-2016 in a single tertiary university-affiliated medical center. Included were patients aged 65 and older who had undergone hip fracture surgery and were admitted to either a geriatric or orthopedic ward. Results: 441 patients met the inclusion criteria (195 in the OG unit, 246 in the OD); 257 were transferred to an affiliated geriatric center hospital (107 from the OG unit and 127 from the OD) for rehabilitation. Patients in the OG unit were older, more cognitively and functionally impaired and with more comorbidities. The 1-year mortality rate was significantly lower in the OD group (OR 0.32, CI 95% 0.19-0.53, p < 0.001), however, after propensity matching, the 30-day and 1 year mortality rates were similar in both groups. No difference was found in the rehabilitation length of stay between the groups. The functional independence measure improvement was similar in both groups, with a non-significant trend toward better functional improvement among OG unit patients. Conclusions: Despite the higher complexity of patients, worse baseline functional capacity in the OG unit, improvement after rehabilitation was similar in both groups. These results demonstrate the advantages of the OG unit in treating and stabilizing frail older adults, thus maximizing their chances for a successful recovery after hip fractures. Level of Evidence: Level IV

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The association between medication or alcohol use and the incidence of frailty: a retrospective cohort study

BMC Geriatrics ◽

10.1186/s12877-020-01969-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Janja Jazbar ◽

Igor Locatelli ◽

Mitja Kos

Keyword(s):

Older Adults ◽

Cohort Study ◽

Alcohol Use ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Medication Use ◽

Reverse Causality ◽

Hazardous Alcohol Use ◽

Modifiable Factors ◽

Hazardous Alcohol

Abstract Background Understanding potentially modifiable factors that influence the risk of frailty is a key concern for the management of this urgent contemporary public health challenge. This study evaluates the association between the use of various medications or alcohol and the incidence of frailty among older adults. Methods This study was a retrospective cohort study on older adults (≥ 65 years) using data from the longitudinal Survey of Health, Ageing and Retirement in Europe (SHARE survey, 28 countries). Medication use was measured as taking several different groups of medications. Alcohol use was assessed with SHARE questions corresponding to AUDIT-C. The outcome measure was the incidence of frailty after two years, defined by frailty index (FI) and frailty phenotype (FP). A multiple logistic regression model was used to evaluate the association with adjustment for several potential confounding factors. Results Of the 14,665 FI-population participants, 1800 (12.3%) developed frailty within two years. Of the 8133 FP-population participants, 2798 (34.4%) developed pre-frailty and 247 (3.0%) developed frailty within two years of baseline. After adjustment for potential confounding variables, non-hazardous alcohol use (adjusted OR; 95% CI for the FI-population: 0.68; 0.60–0.77) and hazardous alcohol use (0.80; 0.68–0.93) are associated with lower incidence of frailty compared to no alcohol use. The odds of frailty are increased when taking medications; the largest effect size was observed in older adults taking medication for chronic bronchitis (adjusted OR; 95% CI for the FI-population: 2.45; 1.87–3.22), joint pain and other pain medication (2.26; 2.00–2.54), medication for coronary and other heart disease (1.72; 1.52–1.96), medication for diabetes (1.69; 1.46–1.96), and medication for anxiety, depression and sleep problems (1.56; 1.33–1.84). Additionally, the risk of frailty was increased with stroke, Parkinson’s disease and dementia. Conclusions Taking certain groups of medication was associated with increased incidence of frailty and pre-frailty, which might be due to either medication use or the underlying disease. Alcohol use was associated with a lower risk of pre-frailty and frailty compared to no alcohol use, which might be due to reverse causality or residual confounding. There was no significant interaction effect between medication groups and alcohol use on frailty incidence.

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