Older age has been recognized as a major risk factor for infection in patients with RA. However, there is very limited data on infection risk noted in elderly RA patients receiving targeted therapy (TT) (i.e., bDMARDs and Janus kinase inhibitors). Considering the comorbidities and treatment-related risks, it is often challenging to adopt the same treatment strategy in elderly patients as that of non-elderly. A recent study published in the Arthritis Research & Therapy has reported that the incidence of hospitalization risk (HI) associated with TT is not significantly higher than that with MTX in elderly patients.
The study carried out by a group of Japanese researchers investigated the incidence rate (IR) of HI per 100 patient-years in the young, elderly, and older elderly groups of age category 16–64, 65–74, and 75 years, respectively). In the young, elderly, and older elderly categories, the overall incidence rate of HI per 100 patient-years was 3.2, 5.0 and 10.1 respectively. In the elderly and older elderly groups, concurrent use of MTX or immunosuppressive DMARDs with TT was less common. In the young, elderly, and older elderly groups, the adjusted odds ratio of TT vs. MTX for HI noted were 1.3 (p = 0.021), 0.79 (p = 0.084), and 0.73 (; p = 0.015), respectively. The overall IR of HI increased with advancing age.
Sakai et al and co-researchers concluded that when compared to young patients, the overall incidence of HI was greater in both elderly and older elderly patients, but the risks of HI in both elderly and older elderly patients exposed to TT versus MTX were found to be similar. These study findings imply that TT can be safely administered to senior and older elderly RA patients with careful risk management and treatment adjustments, and that treatment strategy may differ depending on the age group.
Reference: Sakai R, Tanaka E, Majima M, Harigai M. Unincreased risk of hospitalized infection under targeted therapies versus methotrexate in elderly patients with rheumatoid arthritis: a retrospective cohort study. Arthritis Res Ther. 2022 Jun 10;24(1):135.