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.

THU0172 Adverse Events to Biologic Agents in Elderly Patients with Rheumatoid Arthritis: Cohort with 13 Years of Follow-up: Table 1

2015 ◽  
Vol 74 (Suppl 2) ◽  
pp. 256.2-256
Author(s):  
Z. Rosales Rosado ◽  
D. Freites Núñez ◽  
A. Gόmez Gόmez ◽  
L. Arietti Lόpez ◽  
P. Macarrόn Pérez ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Adverse Events ◽  
Elderly Patients ◽  
Biologic Agents ◽  
Rheumatoid Arthritis Cohort

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.

Risk factors of adverse events during treatment in elderly patients with rheumatoid arthritis: an observational study

2014 ◽  
Vol 20 (3) ◽  
pp. 346-352 ◽  
Author(s):  
Nozomi Iwanaga ◽  
Kazuhiko Arima ◽  
Kaoru Terada ◽  
Yukitaka Ueki ◽  
Yoshiro Horai ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Adverse Events ◽  
Observational Study ◽  
Elderly Patients

Identification of the Risk Factors of Postoperative Pulmonary Complications in Elderly Patients Undergoing Elective Colorectal Surgery

2020 ◽  
pp. 000313482095030
Author(s):  
Jun Chai ◽  
Aming Sang ◽  
Meiyue Tan ◽  
Bo Long ◽  
Lina Chen
Keyword(s):  
Risk Factors ◽  
Colorectal Surgery ◽  
Myocardial Ischemia ◽  
Elderly Patients ◽  
Pulmonary Complications ◽  
Older Age ◽  
Pulmonary Diseases ◽  
Postoperative Pulmonary Complications ◽  
Elective Colorectal Surgery ◽  
Independent Risk Factors

Objective This study was to identify the perioperative related risk factors of postoperative pulmonary complications (PPCs) in elderly patients undergoing elective colorectal surgery, which will provide new insight for better prevention and intervention of PPCs in elderly patients. Methods A retrospective study involving 445 patients (age ≥65), who registered in Shengjing Hospital affiliated to China Medical University for elective colorectal surgery from October 2014 to March 2017, was conducted. Clinical data, including demographic information, medical history, preoperative examination, and surgery-related factors, were analyzed and compared between the patient group with PPCs and the group without PPCs. t-test or χ2 test was performed for statistical analysis between the 2 groups. Binary logistic regression analysis was further employed to identify the potential independent risk factors of PPCs. Results Among the 445 patients enrolled in the study, 49 (11%) had PPCs, while 396 (89%) did not. The main risk factors of PPC occurrence in the elderly patients undergoing elective colorectal surgery included older age (age ≥75 years), ASA >II, hypertension, myocardial ischemia, basic pulmonary diseases, laparotomy, blood transfusion, preoperative hemoglobin <100 g/L, and albumin <35 g/L. Laparotomy (compared with laparoscope) and ASA >II were independent risk factors for the increased incidence of PPCs. Conclusion More attention should be paid to patients with older age and ASA >II in elective colorectal surgery. Choice of laparoscopic operation, proper treatment of hypertension, myocardial ischemia, basic pulmonary diseases, and correction of anemia and nutritional status can effectively reduce the incidence of PPCs. An adequate and comprehensive evaluation of the potential risk factors related to PPCs is required before surgery.

scholarly journals Analysis of Effectiveness, Safety, and Bleeding Related to Rivaroxaban in Elderly Patients

2020 ◽  
Vol 26 ◽  
pp. 107602962092592
Author(s):  
Huimin Hou ◽  
Ang Li ◽  
Liping Zhang ◽  
Xiujiao Qin ◽  
Yanfang Jiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Multivariate Logistic Regression Analysis ◽  
The Elderly ◽  
Multivariate Logistic Regression ◽  
Bleeding Events ◽  
Old Patients ◽  
Daily Dose ◽  
Independent Risk Factors ◽  
Different Doses

This study explored the efficacy and safety of rivaroxaban in elderly patients, at different doses and age of patients, and analyzed risk factors of bleeding. A retrospective analysis was conducted of 299 patients aged 60 years or older who were admitted to the First Hospital of Jilin University between January 2016 and August 2018. It was found that the rate of bleeding events (but not embolism) significantly increased as the dose of oral rivaroxaban increased ( P < .001), and with age, especially in patients aged ≥80 years ( P = .001, both). The multivariate logistic regression analysis indicated that age (odds ratio [OR]: 2.963, 95% CI: 1.627-5.396) and the daily dose of rivaroxaban (OR: 2.325, 95% CI: 1.483-3.645) were independent risk factors for bleeding. The study determined that rivaroxaban anticoagulant therapy is effective in the elderly patients, but the risk of bleeding increases with age, and is a concern especially in the most old patients. The recommended daily dose of rivaroxaban is effective, but a lower dose is safer for the elderly patients.

scholarly journals Age-Associated Changes in Adverse Events Arising From Anti-PD-(L)1 Therapy

2021 ◽  
Vol 11 ◽  
Author(s):  
Xinyi Huang ◽  
Tiantian Tian ◽  
Yan Zhang ◽  
Shengjian Zhou ◽  
Pingping Hu ◽  
...  
Keyword(s):  
Adverse Events ◽  
Elderly Patients ◽  
Pulmonary Toxicity ◽  
Immune Cell ◽  
Adverse Event Reporting System ◽  
Young Patients ◽  
Cell Infiltration ◽  
Immune Cell Infiltration ◽  
Data Set ◽  
Old Patients

BackgroundImmune-related adverse events (irAEs) may complicate the immune checkpoint inhibition (ICI) therapy. The effect of age on these irAEs is not elucidated. The aim of the study was to compare the occurrence of irAEs in different age groups.MethodsPatients with lung cancer receiving anti-programmed death- (ligand)1 (PD-(L)1) were selected from the US Food and Drug Administration Adverse Event Reporting System (FAERS) database. Immune cell infiltration data set was obtained from TIMER 2.0 web server. The patients were stratified for age as follows: &lt;65 year-old (young patients, YP), 65 to 75 year-old (middle aged patients, MP), ≥75 year-old (old patients, OP). The severity of irAEs was compared using logistic binary regression model. The distribution differences of immune cell infiltration were estimated using non-parametric tests.ResultsOf all the 17,006 patients treated by anti-PD-(L)1, 7,355 were &lt;65 (YP), 6,706 were 65–75 (MP), and 2,945 were ≥75 (OP). In general, we analyzed a total of 16 irAEs in this article and found that pulmonary toxicity was more frequent in OP (OP vs. YP: OR = 1.45, 95% CI: 1.28–1.64) and MP (MP vs. YP: OR = 1.38, 95% CI: 1.24–1.52), but hepatitis was less frequent in OP (OP vs. YP: OR = 0.56, 95% CI: 0.32–0.97) and MP (MP vs. YP: OR = 0.57, 95%CI: 0.38–0.85). Further analysis demonstrated that older patients showed less B cell, CD8+ T cell and myeloid dendritic cell infiltration than younger patients.ConclusionsElderly patients exhibited higher incidences of pulmonary toxicity, while hepatitis was found at low incidence. Therefore, clinicians should carefully monitor comorbidities in elderly patients.

scholarly journals Impact of cardiovascular disease and risk factors on fatal outcomes in patients with COVID-19 according to age: a systematic review and meta-analysis

Heart ◽  
2020 ◽  
pp. heartjnl-2020-317901
Author(s):  
SungA Bae ◽  
So Ree Kim ◽  
Mi-Na Kim ◽  
Wan Joo Shim ◽  
Seong-Mi Park
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Relative Risk ◽  
Elderly Patients ◽  
Meta Analysis ◽  
Fatal Outcome ◽  
Young Patients ◽  
Lower Prevalence ◽  
Prevalence Rates ◽  
The Impact

ObjectivePrevious studies that evaluated cardiovascular risk factors considered age as a potential confounder. We aimed to investigate the impact of cardiovascular disease (CVD) and its risk factors on fatal outcomes according to age in patients with COVID-19.MethodsA systematic literature review and meta-analysis was performed on data collected from PubMed and Embase databases up to 11 June 2020. All observational studies (case series or cohort studies) that assessed in-hospital patients were included, except those involving the paediatric population. Prevalence rates of comorbid diseases and clinical outcomes were stratified by mean patient age in each study (ranges: <50 years, 50–60 years and ≥60 years). The primary outcome measure was a composite fatal outcome of severe COVID-19 or death.ResultsWe included 51 studies with a total of 48 317 patients with confirmed COVID-19 infection. Overall, the relative risk of developing severe COVID-19 or death was significantly higher in patients with risk factors for CVD (hypertension: OR 2.50, 95% CI 2.15 to 2.90; diabetes: 2.25, 95% CI 1.89 to 2.69) and CVD (3.11, 95% 2.55 to 3.79). Younger patients had a lower prevalence of hypertension, diabetes and CVD compared with older patients; however, the relative risk of fatal outcomes was higher among the former.ConclusionsThe results of the meta-analysis suggest that CVD and its risk factors (hypertension and diabetes) were closely related to fatal outcomes in COVID-19 for patients across all ages. Although young patients had lower prevalence rates of cardiovascular comorbidities than elderly patients, relative risk of fatal outcome in young patients with hypertension, diabetes and CVD was higher than in elderly patients.Prospero registration numberCRD42020198152.

scholarly journals A New Preoperative Risk Score for Predicting Postoperative Complications in Elderly Patients Undergoing Hepatectomy

2021 ◽  
Author(s):  
Koichi Tomita ◽  
Itsuki Koganezawa ◽  
Masashi Nakagawa ◽  
Shigeto Ochiai ◽  
Takahiro Gunji ◽  
...  
Keyword(s):  
Risk Factors ◽  
Skeletal Muscle ◽  
Postoperative Complications ◽  
Elderly Patients ◽  
Risk Score ◽  
Surgical Procedure ◽  
Evaluation Method ◽  
Preoperative Risk ◽  
Preoperative Serum ◽  
Independent Risk Factors

Abstract Background Postoperative complications are not rare in the elderly population after hepatectomy. However, predicting postoperative risk in elderly patients undergoing hepatectomy is not easy. We aimed to develop a new preoperative evaluation method to predict postoperative complications in patients above 65 years of age using biological impedance analysis (BIA). Methods Clinical data of 59 consecutive patients (aged 65 years or older) who underwent hepatectomy at our institution between 2017 and 2020 were retrospectively analyzed. Risk factors for postoperative complications (Clavien-Dindo ≥ III) were evaluated using multivariate regression analysis. Additionally, a new preoperative risk score was developed for predicting postoperative complications. Results Fifteen patients (25.4%) had postoperative complications, with biliary fistula being the most common complication. Abnormal skeletal muscle mass index from BIA and type of surgical procedure were found to be independent risk factors in the multivariate analysis. These two variables and preoperative serum albumin levels were used for developing the risk score. The postoperative complication rate was 0.0% with a risk score of ≤ 1 and 57.1% with a risk score of ≥ 4. The area under the receiver operating characteristic curve of the risk score was 0.810 (p = 0.001), which was better than that of other known surgical risk indexes. Conclusion Decreased skeletal muscle and the type of surgical procedure for hepatectomy were independent risk factors for postoperative complications after elective hepatectomy in elderly patients. The new preoperative risk score is simple, easy to perform, and will help in the detection of high-risk elderly patients undergoing elective hepatectomy.

scholarly journals Clinical Study on Characteristics and Risk Factors of Coronary Artery Lesions in Young Patients with Acute Myocardial Infarction

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Hua Liu ◽  
Jiangang Zhang ◽  
Zengcai Ma ◽  
Zesheng Xu
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Elderly Patients ◽  
Collateral Circulation ◽  
Young Patients ◽  
Coronary Artery Lesions ◽  
Dominant Type ◽  
Factors Affecting

Epidemiological evidence suggests that the incidence of acute myocardial infarction (AMI) among people under 40 years of age has an increasing trend in recent years. Smoking, hypertension, diabetes mellitus, family history, and gender (male) are considered as classic risk factors for CHD, but the pathogenesis of CHD in young people is not exactly the same. Moreover, the relationship between the pattern of coronary artery disease and risk factors in young patients with acute myocardial infarction is inconclusive. In this study, we retrospectively studied the clinical data of 150 AMI patients treated in our hospital from January 2020 to May 2021. The patients were divided into the young group and elderly group according to the difference in age. The number of coronary artery lesions, the degree of coronary artery stenosis, the distribution dominance typing, the position of the lesions, and the presence of collateral circulation were observed and compared between the two groups. Multivariate logistic regression analysis was used to investigate the risk factors affecting coronary artery lesions in young patients with AMI. The results showed that the number of coronary lesions in young patients with AMI was mainly single-vessel, and the dominant type of distribution was mainly right dominant type. The stenosis degree is lighter than that of elderly patients, and the incidence of collateral circulation is lower than that of elderly patients, but the position of the lesions has no obvious regular. Smoking, staying up late, HDL-C, and LDL-C/ApoB were independent factors affecting the number of coronary artery lesions, and the changes of HDL-C and LDL-C/ApoB had an important influence on the degree of coronary stenosis in young patients. This provides a new idea for clinical treatment.

scholarly journals Assessment of risk of falls and internal risk factors in elderly patients who need heart pacemarkers

2021 ◽  
Vol 2 (9 (297)) ◽  
pp. 1-8
Author(s):  
Guoda Burneikaitė ◽  
Lina Spirgienė
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Fall Risk ◽  
Pacemaker Implantation ◽  
Leg Pain ◽  
Old Patients ◽  
Fall Risk Factor ◽  
Fall Risk Factors ◽  
Experienced Fatigue ◽  
Risk Of Falls

Abstract. The aim is to assess the frequency of falls and intrinsic fall risk factors in patients requiring pacemakers. Methodology. The research was conducted from November 2020 to February 2021. Participated patients were hospitalized at the LUHS hospital Kauno Klinikos Department of Cardiology and required heart pacemaker implantation. Total 82 patients participated in the study. The questionnaire was composed by the authors of the research. The study was obtained by the Bioethics Permit of the Medical Academy of LUHS (No. BEC-SL (B) -42). Results. Almost half of the patients fell (45.1%) at least once a year. Elderly patients (65 years and older) are more likely to experience falls than patients under 65 years of age p=0,006. Elderly patients are more often exposed to various internal risk factors of falls: urination at night (82,9 %), weakness (82,9 %), dizziness (76,8 %). Perceived decreased leg muscle strength was found in both women and men (69.6% and 52.8%, respectively, p = 0.002). Patients older than 65 years and therefore <65 years experienced leg pain (54,9% and 7,2%, respectively, p = 0.002), urination at night (68,4% and 14,6%, respectively, p = 0.009), and experienced fatigue (63,0% and 13,6%, p = 0.028). Conclusions. Almost half of the patients who were in need of heart pacemaker implantation experienced falls. ≥ 65 years old patients experienced falls more than once a year. It has been found that these patients often experience weakness, fatigue, and dizziness. A common intrinsic fall risk factor is urination at night. ≥ 65 years old patients have more internal falls risk factors than patients under 65 years old.

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