Therapie mit Biologika bei älteren Patienten mit rheumatoider Arthritis – Ergebnisse aus dem deutschen Biologika-Register RABBIT

BACKGROUND: Increased comorbidity and frequent comedication complicate the treatment of rheumatoid arthritis (RA) in higher age groups. We investigated the frequency of serious adverse events under biologic or conventional DMARD therapy with specific regard to patients of higher age. METHODS: The German biologics register RABBIT is a prospective long-term observational study of patients with RA from onset of therapy with biologic agents or conventional DMARDS. All patients are observed for at least five years. At fixed time points the course of disease, the medication and all adverse events are recorded by the physician. RESULTS: The mean age of the 5 275 patients included in the analysis was 54.7 years. One-fourth were older than 65, and 70% had at least one other chronic disease. The spectrum of comorbidities was comparable to that of the normal population. The risk for serious infections increased with age in both therapeutic groups. However, it was generally higher in patients treated with biologic agents independent of age. Major risk factors for sepsis were high age, chronic kidney disease or COPD, as well as therapy with glucocorticoids above a dosage of 10 mg/day. The risk of reactivation of a latent tuberculosis increased with age: it was 1.1/1 000 patient years (pyrs) at ages under 49 and 2.6 per 1 000 pyrs at ages above 65. Glucocorticoids were more often prescribed to older patients: 79% of the patients at ages up to 49 compared to 83% of those at ages above 65 received this therapy at baseline. CONCLUSION: Not surprisingly, we found more comorbidity and a higher rate of serious adverse events in patients of higher age in both therapy groups. When treating elderly patients with biologics the risk of infections should be considered and careful screening for TB should be performed. We did not find any further safety problems in elderly patients. Taking the partly high disease activity and the good therapy response of elderly patients into account, they should be considered for therapy adaptation and escalation in the same manner as younger patients.