RESEARCH - Influence of age on the outcome of anti-TNF therapy in RA

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Ann Rheum Dis. Published Online First: 17 November 2008.

doi:10.1136/ard.2008.094730

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Concise Report

Influence of age on the outcome of anti-TNF therapy in rheumatoid arthritis

B J Radovits 1*, W Kievit 1, J Fransen 2, M AFJ van der Laar 3, T L

Jansen 4, P LCM van Riel 2 and R FJM Laan 2

1 Radboud University Nijmegen Medical Center, Netherlands

2 Radboud University Nijmegen Medical Centre, Netherlands

3 Medisch Spectrum Twente & Universiteit Twente, Netherlands

4 Medisch Centrum Leeuwaarden, Netherlands

Abstract

Objective: To investigate the influence of age on the effectiveness

and tolerance of anti-TNF therapy in a prospective observational

cohort of RA patients during the first year of anti-TNF treatment.

Methods: In total, 730 patients of the DREAM (Dutch Rheumatoid

Arthritis Monitoring) register were categorized into three groups

according to their age at the initiation of anti-TNF therapy (<45

years, 45-65 years and >65 years). Effectiveness of anti-TNF therapy

was primarily assessed by longitudinal analysis of the DAS28 during

the first 12 months of treatment. EULAR criteria for clinical response

and remission, the improvement in functional capacity (HAQ) and the

health-related quality of life (SF-36), tolerance of anti-TNF therapy

and treatment decisions after the cessation of anti-TNF therapy were

also analyzed.

Results: Improvement in disease activity and physical functioning was

significantly less in elderly patients, correcting for relevant

confounders. Elderly patients reached the EULAR categories of

good-responders and remission less often than younger patients. Drug

survival, co-medication use and tolerance were comparable between the

3 age groups.

Conclusion: Anti-TNF therapy appeared to be less effective in elderly

compared to younger RA patients, based on smaller improvements in

DAS28 and HAQ and lower percentages of good response and clinical

remission reached during the first 12 months of treatment.

http://ard.bmj.com/cgi/content/abstract/ard.2008.094730v1?papetoc

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