title: Drug retention and safety of TNF inhibitors in elderly patients with rheumatoid arthritis.
abstract: The concerns about the development of adverse events (AEs) in elderly RA patients as a result of age-related changes in drug metabolism and the presence of comorbid illnesses are emphasizing due to increasing prevalence of rheumatoid arthritis (RA) in old age. However, they tend to be inadequately represented in RA clinical trials because of the exclusion criteria that are commonly applied. The tolerability and safety of TNF inhibitors in elderly patients have not been also evaluated in clinical practice. This study aimed to evaluate the retention rate and safety of TNF inhibitors (TNFI) in elderly RA patients.
  
  
  
  Total 429 RA patients (838 person-years [PYs]) treated with TNFI from a retrospective biologic DMARDs registry. Patients were divided into an elderly (age ≥60 years) and a younger group (<60 years). The drug retention rates of both groups were compared using Kaplan-Meier curves. Potential predictors of TNFI discontinuation in the elderly were examined using Cox regression analysis. The incidence rate (IR) of serious adverse events (SAEs) in the elderly group was compared to that of the young group.
  
  
  
  Of the patients, 24.9 % (n = 107, 212 PYs) were in the elderly group. Regarding the retention rates of TNFI in 3 years, there was no significant difference between the elderly and younger group (p = 0.33). The major cause of discontinuation in elderly patients was AE (34.3 %), whereas that was drug ineffectiveness (41.7 %) in younger patients. Age (HR 1.09, CI 1.02-1.16) was a predictor of discontinuation, while the presence of comorbidity (HR 0.37, CI 0.15-0.91) had a protective effect against drug discontinuation in the elderly. The IR of SAEs in the elderly (6.13/100 PYs) was higher than in the younger group (5.11/100 PYs).
  
  
  
  The retention rate of TNFI in the elderly was comparable with that in younger patients. The major cause of discontinuation in the elderly patients was AEs, while it was drug ineffectiveness in younger patients. The IR of SAEs in the elderly was higher than in the younger patients.
authors: Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, 133-792, South Korea.|Clinical Research Center for Rheumatoid Arthritis, Seoul, South Korea.
authors: Soo-Kyung
authors: SK
authors: Cho
authors: Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, 133-792, South Korea.|Clinical Research Center for Rheumatoid Arthritis, Seoul, South Korea.
authors: Yoon-Kyoung
authors: YK
authors: Sung
authors: Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, 133-792, South Korea.|Clinical Research Center for Rheumatoid Arthritis, Seoul, South Korea.
authors: Dam
authors: D
authors: Kim
authors: Clinical Research Center for Rheumatoid Arthritis, Seoul, South Korea.
authors: Soyoung
authors: S
authors: Won
authors: Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, 133-792, South Korea.|Clinical Research Center for Rheumatoid Arthritis, Seoul, South Korea.
authors: Chan-Bum
authors: CB
authors: Choi
authors: Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, 133-792, South Korea.
authors: Tae-Hwan
authors: TH
authors: Kim
authors: Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, 133-792, South Korea.
authors: Jae-Bum
authors: JB
authors: Jun
authors: Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, 133-792, South Korea.
authors: Dae-Hyun
authors: DH
authors: Yoo
authors: Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, 133-792, South Korea. scbae@hanyang.ac.kr.|Clinical Research Center for Rheumatoid Arthritis, Seoul, South Korea. scbae@hanyang.ac.kr.
authors: Sang-Cheol
authors: SC
authors: Bae
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D012189:Retrospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha
keywords: Drug retention rate; Elderly; Rheumatoid arthritis; Safety; TNF inhibitor