title: Effectiveness and safety of abatacept in elderly patients with rheumatoid arthritis enrolled in the French Society of Rheumatology's ORA registry.
abstract: OBJECTIVE
  To study the effect of age on the risk-benefit balance of abatacept in RA.
  
  
  METHODS
  Data from the French orencia and RA registry, including a 2-year follow-up, were used to compare the effectiveness and safety of abatacept according to age.
  
  
  RESULTS
  Among the 1017 patients, 103 were very elderly (⩾75 years), 215 elderly (65-74), 406 intermediate aged (50-64) and 293 very young (<50). At baseline, elderly and very elderly patients had longer disease duration, higher CRP levels and higher disease activity. These age groups showed a lower incidence of previous anti-TNF therapy and less common concomitant use of DMARDs, but a similar use of corticosteroid therapy. After adjusting for disease duration, RF/ACPA positivity, use of DMARDs or corticosteroids and previous anti-TNF treatment, the EULAR response (good or moderate) and the remission rate were not significantly different between the four age groups. At 6 months, the very elderly had a significantly lower likelihood of a good response than the very young (odds ratio = 0.15, 95% CI: 0.03, 0.68). The decrease in DAS28-ESR over the 24-month follow-up period did not differ by age. Increasing age was associated with a higher rate of discontinuation for adverse events, especially severe infections (per 100 patient-years: 1.73 in very young, 4.65 in intermediates, 5.90 in elderly, 10.38 in very elderly; P < 0.001).
  
  
  CONCLUSIONS
  The effectiveness of abatacept is not affected by age, but the increased rate of side effects, especially infections, in the elderly must be taken into account.
authors.affiliation: Department of Internal Medicine, Hôpital Estaing.
authors.forename: Clément
authors.initials: C
authors.lastname: Lahaye
authors.affiliation: Department of Rheumatology, Hôpital Gabriel Montpied msoubrier@chu-clermontferrand.fr.
authors.forename: Martin
authors.initials: M
authors.lastname: Soubrier
authors.affiliation: Biostatistics Unit, La Délégation Recherche Clinique et Innovation, CHU de Clermont-Ferrand, Clermont-Ferrand.
authors.forename: Aurélien
authors.initials: A
authors.lastname: Mulliez
authors.affiliation: Department of Rheumatology, Hôpital Lariboisière, Assistance Publique, Hôpitaux de Paris, Paris.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bardin
authors.affiliation: Department of Rheumatology, Purpan Hospital, Toulouse.
authors.forename: Alain
authors.initials: A
authors.lastname: Cantagrel
authors.affiliation: Department of Rheumatology, Hôpital Lapeyronie, Montpellier, Université Montpellier I, Montpellier.
authors.forename: Bernard
authors.initials: B
authors.lastname: Combe
authors.affiliation: Department of Rheumatology, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris INSERM (U1153), Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris.
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
authors.affiliation: Department of Rheumatology, Lille Teaching Hospital, Lille.
authors.forename: René-Marc
authors.initials: RM
authors.lastname: Flipo
authors.affiliation: Department of Rheumatology, Rouen Teaching Hospital, Rouen.
authors.forename: Xavier
authors.initials: X
authors.lastname: Le Loët
authors.affiliation: Department of Rheumatology, Bordeaux Teaching Hospital, Bordeaux.
authors.forename: Thierry
authors.initials: T
authors.lastname: Shaeverbeke
authors.affiliation: Centre d'Epidémiologie Clinique, Hotel Dieu, Assistance Publique, Hôpitaux de Paris.
authors.forename: Philippe
authors.initials: P
authors.lastname: Ravaud
authors.affiliation: Department of Rheumatology, Hôpital Bicêtre, Assistance Publique, Hôpitaux de Paris and.
authors.forename: Xavier
authors.initials: X
authors.lastname: Mariette
authors.affiliation: Department of Rheumatology, Strasbourg Teaching Hospital, Strasbourg, France.
authors.forename: Jacques-Eric
authors.initials: JE
authors.lastname: Gottenberg
mesh_terms: D000069594:Abatacept / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D009894:Opportunistic Infections / Q000139:chemically induced; D011446:Prospective Studies; D012042:Registries; D012074:Remission Induction; D018570:Risk Assessment / Q000379:methods; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents; D000069594:Abatacept
keywords: abatacept; effectiveness; elderly; management; rheumatoid arthritis; safety