SAT0210 Treatment retention rate of biological treatment in elderly rheumatoid arthritis patients compared with younger rheumatoid arthritis patients – a single center cohort study -
Authors: Y. Hirano, K. Hattori, R. Yamada, Y. Oishi
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background:</h3> Biological (BIO) therapy has become a standard therapy in the treatment of rheumatoid arthritis (RA) and long-term outcomes has increasingly evaluated. Elderly people has increased in Japan and 27.3% of whole people in Japan was 65 years of age or older in 2016. We reported treatment retention rate of BIO therapy in RA patients in EULAR2015 annual meeting as mixed data of elderly RA patients (ERA) and younger RA patients (YRA)<sup> 1)</sup>. <h3>Objectives:</h3> This observational cohort study investigated the treatment retention rate in ERA compared with YRA. <h3>Methods:</h3> Toyohashi RA Database (TRAD) was used. 330 RA patients who initiated any of BIO agents (infliximab, etanercept, adalimumab, tocilizumab, abatacept, golimumab, infliximab-BS) as first Bio in our institute from 2003 to 2016 were included in this study. Switching from one Bio agent to another was defined as continuation of Bio therapy in this study. Stopping of BIO therapy was defined as non-administration for longer than 3 months for any reasons other than remission and pregnancy related. We divided whole patients into two categories using age at initiation of BIO therapy such as YRA (64 years of age or younger) and ERA (65 years of age or older). ERA was further subdivided into two categories such as yERA (65–74 years of age) and oERA (75 years of age or older). We investigated patients' characteristics, treatment retention rate by Kaplan-Meier method and reasons of stopping BIO therapy and compared them between categories. <h3>Results:</h3> Baseline characteristics at the initiation of BIO treatment: %female was 82.4%. Mean age was 58.1 years old (210 YRA, 98 yERA and 22 oERA). Mean RA duration was 10.9 years. % methotrexate (MTX) concomitant was 82.1% and mean used dose was 8.9 mg/weeks (MTX dose was restricted up to 8 mg/weeks until 2011 in Japan and 16 mg/w after 2011). % prednisolone (PSL) concomitant was 50.9%. % Bio monotherapy was 9.1%. Mean baseline DAS28-CRP and SDAI was 4.6 and 24.4, respectively. % high disease activity measured using DAS28 and SDAI at baseline was 44.4% and 42.2%, respectively (Fig1). Baseline disease activity were getting lower year by year. Continuation rate of BIO treatment in whole patients is 88.4% at 1 year, 82.0% at 3 years, 72.2% at 5 year and 57.1% at 10 years. There were significant differences in continuation rate of BIO treatment between YRA and ERA (Fig2), between YRA and yERA and between YRA and oERA, but not between yERA and oERA. Major reasons (over 10%) of stopping BIO therapy in YRA were infection other than respiratory system (15.7%), infection of respiratory systems (11.8%), ineffectiveness (11.8%) and malignancy (11.8%). Major reasons in ERA were infection of respiratory systems (21.3%) and infection other than respiratory systems (10.6%). YRA: younger RA patients, ERA: elderly RA patients <h3>Conclusions:</h3> Although continuation rate of BIO treatment in ERA was inferior to that in YRA, that in yERA was not significantly different from that in oERA. Serious infection, especially in respiratory systems, was most frequent reason for stopping BIO therapy in ERA. These results suggested that BIO therapy in ERA demands close attention to infection and special strategies might need in the treatment of ERA people. <h3>Reference</h3> [1] Hirano Y, et al. Ann Rheum Dis2015;74:700. <h3>Disclosure of Interest:</h3> None declared