title: Overview of biologic treatments in the elderly.
abstract: As life expectancies rise, the number of elderly people with inflammatory rheumatic diseases will continue to grow. Treatment of this frail population, whose clinical features differ from those of younger subjects, poses new challenges to healthcare systems. However, this issue is rarely addressed in the current literature. Thanks to their targeted mechanism of action, biologics represent one of the major therapeutic advances of the last 15 years, but their use in the elderly has been slow in developing. Published data, derived mainly from cohorts, focus on the use of TNF inhibitors in rheumatoid arthritis and show that these treatments are effective and generally well tolerated. Nevertheless, the risk of infection and cancer, particularly skin and lymphoid malignancies, must not be neglected. The use of these biologics as second-line treatment improves patient outcomes and comfort, while reducing consumption of the widely used and more deleterious drugs such as glucocorticoids and non-steroidal anti-inflammatory drugs. Additional studies on biologics, focusing on the longer term and in indications apart from anti-TNF therapies in rheumatoid arthritis should help overcome some of the reluctance and promote the rational use of these drugs in the elderly.
authors.affiliation: CHU (University Hospital Center) Clermont-Ferrand, Department of Internal Medicine, Hôpital Estaing, Clermont-Ferrand, France.
authors.forename: Clément
authors.initials: C
authors.lastname: Lahaye
authors.affiliation: CHU Clermont-Ferrand, Department of Rheumatology, Hôpital Gabriel Montpied, Clermont-Ferrand, France.
authors.forename: Zuzana
authors.initials: Z
authors.lastname: Tatar
authors.affiliation: CHU Clermont-Ferrand, Department of Rheumatology, Hôpital Gabriel Montpied, Clermont-Ferrand, France.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Dubost
authors.affiliation: CHU Clermont-Ferrand, Department of Rheumatology, Hôpital Gabriel Montpied, Clermont-Ferrand, France. Electronic address: msoubrier@chu-clermontferrand.fr.
authors.forename: Martin
authors.initials: M
authors.lastname: Soubrier
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000628:therapy*; D001688:Biological Products / Q000627:therapeutic use*; D006801:Humans; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; D014409:Tumor Necrosis Factor-alpha
keywords: Biotherapies; Efficacy; Elderly; Inflammatory rheumatism; Management; Safety