The safety and effectiveness of tocilizumab in elderly patients with rheumatoid arthritis and in patients with comorbidities associated with age
C. Specker1, M. Aringer2, G.-R. Burmester3, B. Killy4, M.W. Hofmann5, H. Kellner6, F. Moosig7, H.-P. Tony8, G. Fliedner9
- Clinic of Rheumatology and Clinical Immunology, Clinic Essen-Mitte, Essen, Germany. email@example.com
- Department of Medicine III, University Medical Center Carl Gustav Carus, Dresden University of Technology, Dresden, Germany.
- Department of Rheumatology and Clinical Immunology Charité - Universitätsmedizin Berlin, Free University and Humboldt University Berlin, Germany.
- Rheumatology, Roche Pharma AG, Grenzach-Wyhlen, Germany.
- Rheumatology, Chugai Pharma Germany GmbH, Frankfurt am Main, Germany.
- Rheumatology and Gastroenterology Specialty Practice, Munich, Germany.
- Rheumatology Center Schleswig-Holstein Middle, Neumünster, Germany.
- Medical Clinic II, Department of Rheumatology and Clinical Immunology, University Clinic Würzburg, Germany.
- Rheumatology Practice, Osnabrück, Germany.
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PMID: 34874836 [PubMed]
Accepted : 04/10/2021
In Press: 22/11/2021
To examine the safety and effectiveness of long-term tocilizumab treatment in elderly patients with rheumatoid arthritis (RA) and patients with age-associated comorbidities.
ICHIBAN (NCT01194401) was a prospective, non-interventional study that observed adult patients with active moderate-to-severe RA in German rheumatology clinics and practices for up to two years. Patients were to be treated according to the tocilizumab label. Here, we present safety and effectiveness data analysed according to patient age.
Of the 3,164 patients treated with at least one dose of tocilizumab, 924 patients were <50 years old, 1496 patients were 50–65 years old, and 744 patients were >65 years old at baseline. Patients >65 years had the highest baseline DAS28-ESR, CDAI, and HAQ-DI scores, along with the highest burden of comorbidities, such as diabetes, coronary heart disease, anaemia, and renal insufficiency. Under treatment with tocilizumab, patients >65 years had similar improvements in DAS28-ESR, CDAI and patient-reported outcomes (fatigue, pain, sleeplessness) with similar glucocorticoid savings compared to patient groups <65 years. Patients >65 years with late-onset RA achieved similar reductions in disease activity compared to early-onset patients. Despite numerically higher rates of adverse events (AEs), serious AEs and serious infections in patients >65 years, there were similar rates of AEs leading to withdrawal.
Elderly patients in ICHIBAN experienced improvements similar to younger patients in most effectiveness endpoints with only slightly higher rates of AEs, indicating an overall net-positive risk-benefit ratio of tocilizumab treatment regardless of patient age.