title: [Systematic review: safety and efficacy of anti-TNF in elderly patients].
abstract: OBJECTIVE
  To evaluate whether the safety and efficacy of anti-TNF treatments in elderly patients with rheumatic diseases is similar than the safety and efficacy of the same drugs in younger patients.
  
  
  METHODS
  Systematic review. We performed a systematic search in MEDLINE (Pubmed), EMBASE (Ovid), and the Cochrane Library Plus. Abstracts published in the American and European rheumatology congresses and articles in Reumatología Clínica were also reviewed.
  
  
  RESULTS
  Ten studies fulfilled the inclusion criteria. Studies show a similar efficacy in elderly and younger patients. The differences between the young and the elderly regarding DAS28 reductions before and after are very small: 0.04 in the Geneway et al study and 0.0 in the Mariette et al study, as well as in the before and after HAQ: 0.04 (Geneway et al), 0.18 (Schiff et al) and 0.06 (Mariette et al).Adverse events reported in elderly and younger patients are 83.3% and 77.1% respectively with etanercept, as reported by Fleischmann; 27.2% vs 12.5%, p=0.19, as reported by Chevillotte, and the rate of withdrawal due to an adverse event was 57,8% vs 29,2% with infliximab, p=0.03, 36% vs 15% p=0.06 with adalimumab and 10,3% and 9,5%, with no significant p value, as reported by Massara.
  
  
  CONCLUSIONS
  The information to assess the efficacy and safety of anti-TNF therapy in elderly patients was obtained in all cases from sub analyses and therefore bias is possible. We can say, with a low to moderate level of evidence, that elderly patients undergoing anti-TNF treatments have a higher number of adverse events, and similar efficacy, when compared with younger patients.
authors.affiliation: Servicio de Reumatología, Hospital de Granollers, Granollers, Barcelona, España. noemibp76@hotmail.com
authors.forename: Noemi
authors.initials: N
authors.lastname: Busquets
authors.forename: Loreto
authors.initials: L
authors.lastname: Carmona
authors.forename: Xavier
authors.initials: X
authors.lastname: Surís
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D000068800:Etanercept; D019317:Evidence-Based Medicine; D006801:Humans; D016867:Immunocompromised Host; D007074:Immunoglobulin G / Q000009:adverse effects / Q000627:therapeutic use*; D000069285:Infliximab; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D009369:Neoplasms / Q000453:epidemiology / Q000209:etiology; D009894:Opportunistic Infections / Q000453:epidemiology / Q000209:etiology; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D012216:Rheumatic Diseases / Q000188:drug therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept