title: Efficacy and safety of tocilizumab in elderly patients with rheumatoid arthritis.
abstract: OBJECTIVE
  To assess the safety and efficacy of tocilizumab (TCZ) in elderly (≥65 years) rheumatoid arthritis (RA) patients treated in daily practice.
  
  
  METHODS
  We conducted a retrospective study of TCZ use in RA patients in five French university hospitals between 2009 and 2012. We considered two age groups, under 65 years (<65) and over 65 years (≥65). TCZ efficacy was evaluated at 24 weeks by the European League Against Rheumatism (EULAR) response and remission score. We also evaluated drug maintenance and safety, relative to adverse events discontinuation. A multivariate cumulative logit model for ordinal categories was performed to assess the relationship between age class and EULAR response (none, moderate and good) adjusted on possible confounders. TCZ retention (drug survival) over time was estimated with the Kaplan-Meier method. Treatment retention curves were compared according to age group with the log-rank test.
  
  
  RESULTS
  Among 222 RA patients treated with TCZ, 61 (27.5%) were≥65 years at the initiation of treatment. After 6 months, this elderly patient group less often reached remission (27.8% versus 45.6%; P=0.02) or good EULAR response (40.7% versus 61.0%; P<0.01) compared to the younger patient group (<65). Multivariate analysis adjusted on baseline C-reactive protein and disease duration confirmed that elderly patients were more likely to have a lower EULAR response (none vs moderate-good or none-moderate vs good) (OR: 3.63; 95% CI [1.86-7.06], P<0.001) compared to younger patients. Drug maintenance for TCZ and adverse events discontinuation rates were similar between the two age groups.
  
  
  CONCLUSIONS
  In daily practice, TCZ seems to be well tolerated in RA patients but is less efficient in elderly patients. A broader field of analysis to include an international register will be required to confirm these results.
authors.affiliation: Clinical immunology and osteoarticular diseases Therapeutic Unit, Lapeyronie University Hospital, Montpellier, France. Electronic address: ympers2000@yahoo.fr.
authors.forename: Yves-Marie
authors.initials: YM
authors.lastname: Pers
authors.affiliation: Clinical Research and Epidemiology Department, La Colombière University Hospital, Montpellier, France.
authors.forename: Roxane
authors.initials: R
authors.lastname: Schaub
authors.affiliation: Rheumatology Unit, Saint-Étienne University Hospital, Saint-Étienne, France.
authors.forename: Elodie
authors.initials: E
authors.lastname: Constant
authors.affiliation: Rheumatology Unit, Grenoble University Hospital, Grenoble, France.
authors.forename: Joseph
authors.initials: J
authors.lastname: Lambert
authors.affiliation: Rheumatology, Besançon University Teaching Hospital, Besançon, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Godfrin-Valnet
authors.affiliation: Rheumatology, Dijon University Hospital, Dijon, France.
authors.forename: Clémentine
authors.initials: C
authors.lastname: Fortunet
authors.affiliation: Clinical immunology and osteoarticular diseases Therapeutic Unit, Lapeyronie University Hospital, Montpellier, France.
authors.forename: Waafa
authors.initials: W
authors.lastname: Bourichi
authors.affiliation: Rheumatology Unit, Saint-Étienne University Hospital, Saint-Étienne, France.
authors.forename: Béatrice Pallot
authors.initials: BP
authors.lastname: Prades
authors.affiliation: Rheumatology, Besançon University Teaching Hospital, Besançon, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wendling
authors.affiliation: Rheumatology Unit, Grenoble University Hospital, Grenoble, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Gaudin
authors.affiliation: Clinical immunology and osteoarticular diseases Therapeutic Unit, Lapeyronie University Hospital, Montpellier, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Jorgensen
authors.affiliation: Rheumatology, Dijon University Hospital, Dijon, France.
authors.forename: Jean-Francis
authors.initials: JF
authors.lastname: Maillefert
authors.affiliation: Rheumatology Unit, Saint-Étienne University Hospital, Saint-Étienne, France.
authors.forename: Hubert
authors.initials: H
authors.lastname: Marotte
mesh_terms: D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; C502936:tocilizumab
keywords: Drug survival; Efficacy; Elderly; Rheumatoid arthritis; Tocilizumab