Background Although elderly patients with rheumatoid arthritis (RA) are probably the largest group of patients with RA, this age group has been excluded from clinical trials and therefore maximum evidence of effectiveness and safety data is not available. For this reason, it is interesting to conduct a study to evaluate the effectiveness and safety of treatment with anti-tumour necrosis factor (anti-TNF) in an elderly population.
Purpose To analyse and compare the effectiveness and safety of treatment with anti-TNF agents (adalimumab, etanercept and infliximab) in elderly patients (>65 years) with RA.
Material and methods A descriptive and retrospective study was conducted in a tertiary hospital with 800 beds. All patients aged >65 years diagnosed with RA treated with adalimumab, etanercept or infliximab were included from 2013 to 2015. The data analysis was performed using SPSS.
Results The sample for RA patients >65 years was 47 patients. 85% were women. 31.9% (n=15) were treated with infliximab, 29.8% (n=14) with etanercept and 38.3% (n=18) with adalimumab. Mean age was 71.7±5.2 years. At the end of the study period, 46.7% had discontinued treatment with infliximab, 41.2% with adalimumab and 28.6% with etanercept. The main reasons for treatment discontinuation were: remission in 13.3% for infliximab and 11.1% for adalimumab, therapeutic failure in 14.3% for etanercept and 16.6% for adalimumab, and adverse event in 11.1% for adalimumab. Median survival was 11.4 years (95% CI) for infliximab and 9.6 years (95% CI) for adalimumab. For etanercept, the median was not reached at the end of the study period. Survival at 5 years was 73% for infliximab, 75% for etanercept and 62% for adalimumab (log rank p=0.613; Breslow p=0.927). The main adverse effects observed were: infections and respiratory disorders for 3 drugs, followed by vascular disorders and asthenia for infliximab, renal and urinary disorders and eye disorders for adalimumab and gastrointestinal disorders for etanercept.
Conclusion The effectiveness of treatment with etanercept, adalimumab and infliximab in elderly patients showed no statistically significant differences in our study. The main adverse effects were infectious disorders, with the highest prevalence with infliximab and adalimumab.
No conflict of interest
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