Drug tolerability and reasons for discontinuation of seven biologics in elderly patients with rheumatoid arthritis -The ANSWER cohort study

The aim of this study is to evaluate the retention rates and reasons for discontinuation for seven biological disease-modifying antirheumatic drugs (bDMARDs) in a real-world setting of elderly patients (65 years of age or older) with rheumatoid arthritis (RA). This multi-center, retrospective study...

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Bibliographic Details
Published in:PloS one 2019-05, Vol.14 (5), p.e0216624
Main Authors: Ebina, Kosuke, Hashimoto, Motomu, Yamamoto, Wataru, Hirano, Toru, Hara, Ryota, Katayama, Masaki, Onishi, Akira, Nagai, Koji, Son, Yonsu, Amuro, Hideki, Yamamoto, Keiichi, Maeda, Yuichi, Murata, Koichi, Jinno, Sadao, Takeuchi, Tohru, Hirao, Makoto, Kumanogoh, Atsushi, Yoshikawa, Hideki
Format: Article
Language:English
Subjects:
Adalimumab
Age
Aged
Analysis
Antiarthritic agents
Antirheumatic agents
Antirheumatic Agents - administration & dosage
Antirheumatic Agents - adverse effects
Arthritis
Arthritis, Rheumatoid - drug therapy
Behavior
Biological Products - administration & dosage
Biological Products - adverse effects
Biology and Life Sciences
Blood tests
Certolizumab pegol
Cohort analysis
Dosage
Drug therapy
Drug Tolerance
Drug-Related Side Effects and Adverse Reactions - epidemiology
Drugs
Elderly patients
Erythrocyte sedimentation rate
Erythrocytes
Etanercept
Female
Females
Geriatrics
Glucocorticoids
Golimumab
Hazards
Hospitals
Humans
Immunology
Incidence
Infections
Infliximab
Internal medicine
Japan - epidemiology
Joint diseases
Lung diseases
Male
Medical research
Medication Adherence - statistics & numerical data
Medicine
Medicine and Health Sciences
Methotrexate
Monoclonal antibodies
Older people
Patient compliance
Patients
People and Places
Prednisolone
Remission
Research and Analysis Methods
Retention
Retrospective Studies
Rheumatic diseases
Rheumatoid arthritis
Rheumatoid factor
Rheumatology
Steroids (Organic compounds)
Studies
Surgery
TNF inhibitors
Tocilizumab
Treatment Outcome
Tumor necrosis factor-TNF
Tumor necrosis factor-α
Women
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Summary:The aim of this study is to evaluate the retention rates and reasons for discontinuation for seven biological disease-modifying antirheumatic drugs (bDMARDs) in a real-world setting of elderly patients (65 years of age or older) with rheumatoid arthritis (RA). This multi-center, retrospective study assessed 1,098 treatment courses of 661 patients with bDMARDs from 2009 to 2018 (females, 80.7%; baseline age, 71.7 years; disease duration 10.5 years; rheumatoid factor positivity 81.3%; Disease Activity Score in 28 joints using erythrocyte sedimentation rate, 4.6; concomitant prednisolone dose 2.8 mg/day (45.6%) and methotrexate dose 4.4 mg/week (56.4%); and 60.2% patients were bio-naïve). Treatment courses included abatacept (ABT; n = 272), tocilizumab (TCZ; n = 234), etanercept (ETN; n = 184), golimumab (GLM; n = 159), infliximab (IFX; n = 101), adalimumab (ADA; n = 97), and certolizumab pegol (CZP; n = 51). Drug retention rates and discontinuation reasons were estimated at 36 months using the Kaplan-Meier method and adjusted for potential clinical confounders (age, sex, disease duration, concomitant PSL and MTX, starting date and switched number of bDMARDs) by Cox proportional hazards modeling. A total of 51.2% of treatment courses were stopped, with 25.1% stopping due to lack of effectiveness, 11.8% due to toxic adverse events, 9.7% due to non-toxic reasons, and 4.6% due to remission. Drug retention rates for each discontinuation reason were as follows; lack of effectiveness [from 55.4% (ETN) to 81.6% (ABT); with significant differences between groups (Cox P
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0216624