SAN FRANCISCO – Biologics do not pose an increased risk of infection in patients with elderly-onset rheumatoid arthritis over the age of 60 years because their time to first infection and time to multiple infections were not different from people of the same age who developed the disease at a younger age in a large, prospective, longitudinal, observational study .
The data also suggest that noncytotoxic disease-modifying antirheumatic drugs (DMARDs) and non-TNF biologics may have a protective effect against infection in elderly patients with RA regardless of time of disease onset when compared with methotrexate monotherapy.
Sofia Pedro
“Elderly-onset RA [EORA] patients are less likely to be treated with biologics than [are] patients with younger-onset RA [YORA]. This difference may be related to concerns about the risk of serious infections in elderly patients versus younger ones. There are only two papers on this subject in the literature, and now our study shows no increased risk. These findings support providing similar treatment for elderly versus younger-onset RA patients,” lead author Sofia Pedro of the National Data Bank for Rheumatic Diseases, Wichita, Kan., said at the annual meeting of the American College of Rheumatology.
The study was based on people with RA included in the National Data Bank for Rheumatic Diseases followed from 1998 through 2014. Patients filled out questionnaires on demographics, clinical factors, medications, and infections. A total of 1,865 EORA patients (onset older than 60 years) were matched 1:3 with 5,595 YORA patients (onset younger than 60 years) based on age, sex, and year of study entry.
At baseline, all patients were older than 60 years. The median age was between 65 and 70 years.
Serious infections were those that required hospitalization or intravenous antibiotics or caused death. Serious infectious were validated from hospital, physician, and death records. Overall, a total of 1,196 serious infections were reported during the study: 204 (11%) in the EORA group and 992 (18%) in YORA patients. Pneumonia, skin, and sepsis were the most common infections in both groups. Pneumonia was reported in 55% of EORA patients and 66% of the YORA group; skin infections, in 22% vs. 14%, respectively; and sepsis in 16% vs. 17%, respectively. The rate of self-reported prior infections was 4% in EORA patients and 7% in YORA patients (P less than .01). Overall, EORA patients were no quicker to have a first infection or multiple infections than were YORA patients after adjustments for Comorbidity Index, Health Assessment Questionnaire (HAQ), headache, pain, education, ethnicity, prednisone use, and urban versus rural setting.
Treatments were grouped according to noncytotoxic DMARDS; cytotoxic DMARDs; anti-TNF biologics; and non-TNF biologics. Methotrexate monotherapy was the referent. The hazard ratios for time to first infection and time to multiple infections were 0.72 and 0.82, respectively, for non-cytotoxic DMARDs and 0.43 and 0.48, respectively, for non-TNF biologics, all of which were statistically significant after adjustment for confounders.
EORA patients, compared with YORA patients, had greater exposure to prednisone and fewer prior serious infections, shorter disease duration (4.4 years vs. 20.9 years, respectively), lower Comorbidity Index, and more favorable disease markers. YORA patients had greater exposure to TNF biologics.
YORA patients had slightly higher incidence rates across all age groups, except between the ages of 60-70 years, when more infections were reported in EORA patients. The risk for multiple infections was greater in patients aged 80 years and older, but Ms. Pedro noted that covariates, such as HAQ, Comorbidity Index, prior serious infection, and exposure to prednisone, were associated with increased risk.
Ms. Pedro had no financial disclosures.