Effectiveness and safety of abatacept in elderly patients with rheumatoid arthritis enrolled in the French Society of Rheumatology's ORA registry.

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). CONCLUSION: 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.

Influence of gender on response to rituximab in patients with rheumatoid arthritis: results from the Autoimmunity and Rituximab registry.

OBJECTIVE: The response rate to many therapies for RA is lower in women. The aim of this study was to analyse the influence of gender on the response to rituximab (RTX) in patients with RA. METHODS: A total of 1709 RA patients were included in the French Autoimmunity and Rituximab (AIR) registry. Disease activity assessed by the 28-joint DAS (DAS28) was recorded at baseline and at follow-up (6, 12, 18 and 24 months). Response criteria [European League Against Rheumatism (EULAR) remission defined as a DAS28 < 2.6 and EULAR response] were compared in both sexes. RESULTS: Seventy-seven per cent of the patients were female (age 61.4 years, disease duration 16 years). Approximately 78.6% of the patients were positive for RF and 75.8% for anti-CCP. Women had a longer disease duration (P < 0.001), less frequently had anti-CCP (P = 0.03) and had lower CRP levels at baseline (P < 0.001). Six months after RTX, 11% were in remission and 62% had a good to moderate EULAR response, irrespective of gender (P = 0.81 and P = 0.38, respectively). No differences were observed in terms of remission or EULAR response during the follow-up except at 12 months, when men achieved remission more frequently (18% vs 12%, P = 0.045). In the cases of anti-TNF failure, remission rates were higher in men than in women at 6, 12 and 18 months. Re-treatment delay between the first and second courses was similar in both genders (P = 0.26). CONCLUSION: In this large cohort of RA patients we found no significant differences in EULAR response to RTX between men and women during the 2-years of follow-up, but there was a previous anti-TNF exposure-dependent effect of gender on remission rate.

Efficacy and safety of rituximab in elderly patients with rheumatoid arthritis enrolled in a French Society of Rheumatology registry.

OBJECTIVE: The aim of this study was to compare the efficacy and safety of rituximab (RTX) as a function of patient age. METHODS: We included all rheumatoid arthritis patients in the AutoImmunity and Rituximab registry with a 2-year followup. RESULTS: Of the 1,709 patients, 191 were age ≥75 years, 417 were ages 65­74 years, 907 were ages 50­64 years, and 194 were age <50 years. At baseline, the elderly and very elderly patients presented with longer disease duration, a higher incidence of erythrocyte sedimentation rate and C-reactive protein level, a lower incidence of previous tumor necrosis factor α (TNFα) therapy, and a smaller number of previously used TNFα agents. Disease activity, rheumatoid factor (RF), or anti­cyclic citrullinated peptide (anti-CCP) antibodies and corticosteroid therapy were not statistically different among the groups. At 24 months, no significant difference was shown among the groups for RTX discontinuation rates (36.1% if age <50 years, 32.6% if ages 50­64 years, 34.5% if ages 65­74 years, and 32.5% if age >75 years). The reasons for discontinuation (inefficacy, adverse events) were the same in all 4 groups. Infections were more common in the elderly. Patients ages 65­75 years were more likely to be good responders than nonresponders at 1 year of followup than patients age ≥75 years (odds ratio 3.81, 95% confidence interval 1.14­12.79) after adjustment on disease duration, RF/anti-CCP positivity, corticosteroids, anti-TNF use, and baseline Disease Activity Score in 28 joints (DAS28). After the sixth month, the decrease in DAS28 score was less marked in the population age >75 years than in the group age <50 years. CONCLUSION: The efficacy and safety of RTX is affected by age.