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Effectiveness Of TNF-á Inhibitor Therapy Does Not Differ Between Elderly and Younger Patients With Rheumatoid Arthritis: Results From The Corrona Registry

Abstract:
#1435
Presenter:
Martinez-Marti, Melisa M.D.
Co-Authors:
Hopkins, Aviva C. M.D.; Reed, George W. PhD; He, Ping MS; Greenberg, Jeffrey D. MD, MPH; Lozada, Carlos J. MD; Pala, Ozlem M.D.; Kremer, Joel M. MD; Pappas, Dimitrios A. MD, MPH
Date:
Monday, October 28, 2013
Presenter Available:
9:00 am - 11:00 am
Poster Available:
8:30 am - 4:00 pm
Location:
Exhibit Hall B2-C-D
Session Title:
Rheumatoid Arthritis Treatment - Small Molecules, Biologics and Gene Therapy II
Abstract Category:
Rheumatoid Arthritis - Small Molecules, Biologics and Gene Therapy
Type:
Poster
Description:

Background/Purpose: Biologics have revolutionized the therapy and prognosis of patients (pts) with Rheumatoid Arthritis (RA). Studies evaluating whether the effectiveness of TNF-α inhibitor (TNFi) therapy varies by age group are lacking. The present analysis compares the effectiveness of TNFi treatment between older and younger pts with RA.

Methods: Data were obtained from the Consortium of Rheumatology Researchers of North America (CORRONA) registry. We identified RA pts having at least moderate disease activity (CDAI ≥10) who initiated their first TNFi and had a follow up visit 6 months (4-9 months) later. We subsequently compared the odds of achieving low disease activity (LDA), as measured by CDAI, in older (≥65 years old) vs younger (18-64 years old) pts. Non-response was imputed for pts who discontinued the TNFi and switched to another biologic prior to the 6 month follow up visit. The actual 6 months disease activity was used if TNFi was stopped without switching to a different biologic.

Multivariate models (MV) compared the odds of achieving LDA between older and younger pts. Propensity scores (PS) were used to evaluate the probability of pts to belong in the elderly group and were used to fit MV models in two ways: a) After excluding pts in the non overlapping regions of the PS distribution, we adjusted for variables still not balanced after trimming. b) Using the PS to 1:1 match older to younger TNFi initiators we adjusted only for disease duration.

Results: 1415 biologic naïve TNFi initiations were identified: 377 of them were ≥ 65 years old and 1038 pts were < 65 years old. Baseline characteristics in older versus (vs) younger group: 72.4% vs 77.1% women, 88.3% vs 81.7% Caucasian, 74.2% vs 70.2% seropositive. Mean ± SD age was 72.4±6.1 vs 50.8±9.6 years, RA disease duration 10.9±10.8 vs 6.1±7.6 years; CDAI: 25.7± 10.8 vs 26.3±12.8 in older vs younger pts respectively. 82.2% of older pts received the TNFi in combination with non-biologic DMARDs vs 85.4% in the younger group. 72 (19.10%) older pts discontinued the TNFi during the follow up period and 10 of them (2.65%) switched to different biologic vs 180 (17.34%) and 50 pts (4.82%) respectively in the younger group.

After trimming pts in non-overlapping regions of PS, 365 pts remained in the older and 1021 in the younger group. After PS 1:1 matching,  326 pts remained in each group. Table 1 shows the results of unadjusted and adjusted comparisons in the odds of achieving LDA in older and younger pts.

 Conclusion: The effectiveness of TNFi therapy does not differ between older and younger pts with RA based on the current analysis.  This suggests that treatment decisions for those with RA should not be based on age considerations alone.

 

Table 1.

 

Unadjusted Results

Treatment

Odds Ratios

[95% CI]

p-value

Younger patients (N=1038)

1 (referent)

 

 

Older patients (N=377)

0.98

0.76-1.26

0.874

 

Adjusted Results after trimming of patients on non- overlapping Propensity Score* distributions**

Younger patients (N=1021)

1 (referent)

 

 

Older patients (N=365)

0.89

0.67-1.17

0.387

 

Adjusted Results after Propensity Score* 1:1 matching***

Younger patients (N=326)

1 (referent)

 

 

Older patients (N=326)

0.91

0.65-1.27

0.575

* Propensity score variables: gender, functional class, subcutaneous nodules, baseline CDAI, baseline mHAQ score, BMI, smoking status, history of cardiovascular disease, and history of malignancy. 

** adjusted for: gender, functional class, subcutaneous nodules, baseline mHAQ, baseline CDAI, BMI, history of cardiovascular disease, history of malignancy, and smoking status

*** adjusted for: duration of Rheumatoid Arthritis

Disclosure:

A. C. Hopkins, None; M. Martinez-Marti, None; G. W. Reed, Corrona, Inc, 3; P. He, UMASS Medical School, 3; J. D. Greenberg, Corrona, 1, AstraZeneca, 5, Corrona, 5, Novartis Pharmaceutical Corporation, 5, Pfizer Inc, 5; C. J. Lozada, AbbVie, 2, Pfizer Inc, 5; O. Pala, None; J. M. Kremer, Corrona, 1, Corrona, 3; D. A. Pappas, CORRONA Inc, 3, Novartis Pharmaceutical Corporation, 5, Columbia University, 6.