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Manfredi A, Fornaro M, Bazzani C, Perniola S, Cauli A, Rai A, Favalli EG, Bugatti S, Rossini M, Foti R, Conti F, Lopalco G, Scalvini A, Garufi C, Congia M, Gorla R, Gremese E, Atzeni F, Caporali R, Iannone F, Sebastiani M. Retention rate of biologic and targeted synthetic anti-rheumatic drugs in elderly rheumatoid arthritis patients: data from GISEA registry. Front Med (Lausanne) 2024; 11:1349533. [PMID: 38529117 PMCID: PMC10961352 DOI: 10.3389/fmed.2024.1349533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/15/2024] [Indexed: 03/27/2024] Open
Abstract
Objectives An increased number of elderly individuals affected by rheumatoid arthritis (RA) has been reported, including both patients with RA onset in advanced age and patients aged with the disease. In this registry-based study, we aimed to analyze the retention rate and cause of discontinuation of biologic (b) and targeted synthetic (ts)-disease-modifying anti-rheumatic drugs (DMARDs) in RA patients over 65 year old. Methods RA patients enrolled in the Italian GISEA registry and starting a b- or a ts-DMARD over 65 years of age were included. Demographic, clinical, serologic, and therapeutic features were collected. Results A total of 1,221 elderly RA patients were analyzed (mean age 71.6 ± 5.2 years). RA was diagnosed before 65 years in 72.5% of cases, a 60.6% of patients experienced a previous b- or ts-DMARD. In patients older than 65 initiating a new b- or ts-DMARDS, tumor necrosis factor alpha inhibitors (TNFi) were prescribed in 29.6% of patients, abatacept in 24.8%, anti-interleukin 6 receptor antagonists (anti-IL6R) in 16.3%, Janus kinases inhibitors (JAKi) in 24.9%, and rituximab in 4.4%. The main causes of discontinuation were primary or secondary inadequate responses (66.1%). The median retention rate for all treatments was 181.3 weeks. A statistically higher retention rate was observed for abatacept when compared to TNFi (p = 0.02), JAKi (p < 0.001), and anti-IL6R (p < 0.001), and for TNFi vs. JAKi (p = 0.013). Conclusion We described, in a real-life setting, elderly RA patients treated with a biologic or a ts-DMARD in Italy. Loss of efficacy was the main cause of discontinuation, and the DMARD safety profile suggests that age does not contraindicate their use. Our study reinforced that the control of disease activity is mandatory.
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Affiliation(s)
- Andreina Manfredi
- Rheumatology Unit, Azienda Ospedaliera Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Fornaro
- Rheumatology Unit, Department of Precision and Regenerative Medicine and Jonic (DiMePRe-J), University of Bari, Bari, Italy
| | - Chiara Bazzani
- Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | - Simone Perniola
- Clinical Immunology Unit, Department of Geriatrics, Orthopedics and Rheumatology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Alberto Cauli
- Rheumatology Unit, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari Monserrato, Cagliari, Italy
| | - Alessandra Rai
- Rheumatology Unit, Azienda Ospedaliera Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Ennio Giulio Favalli
- Department of Rheumatology and Medical Sciences, ASST Gaetano Pini-CTO, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Serena Bugatti
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Rosario Foti
- Rheumatology Unit, San Marco Hospital, Policlinico University of Catania, Catania, Italy
| | - Fabrizio Conti
- Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari – Rheumatology Unit, Sapienza Università di Roma, Rome, Italy
| | - Giuseppe Lopalco
- Rheumatology Unit, Department of Precision and Regenerative Medicine and Jonic (DiMePRe-J), University of Bari, Bari, Italy
| | - Anna Scalvini
- Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | - Cristina Garufi
- Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari – Rheumatology Unit, Sapienza Università di Roma, Rome, Italy
| | - Mattia Congia
- Rheumatology Unit, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari Monserrato, Cagliari, Italy
| | - Roberto Gorla
- Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | - Elisa Gremese
- Clinical Immunology Unit, Department of Geriatrics, Orthopedics and Rheumatology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Fabiola Atzeni
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Roberto Caporali
- Department of Rheumatology and Medical Sciences, ASST Gaetano Pini-CTO, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Department of Precision and Regenerative Medicine and Jonic (DiMePRe-J), University of Bari, Bari, Italy
| | - Marco Sebastiani
- Rheumatology Unit, Azienda Ospedaliera Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
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Pombo-Suárez M, Seoane-Mato D, Díaz-González F, Sánchez-Alonso F, Sánchez-Jareño M, Cea-Calvo L, Castrejón I. Four-years retention rate of golimumab administered after discontinuation of non-TNF inhibitors in patients with inflammatory rheumatic diseases. Adv Rheumatol 2023; 63:25. [PMID: 37287051 DOI: 10.1186/s42358-023-00296-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/20/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND In patients with rheumatic diseases, the use of biological (b) or targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARDs) after discontinuation of tumor necrosis factor inhibitors (TNFi) is known to be effective. However, data on the use of TNFi after discontinuation of non-TNFi bDMARDs or tsDMARDs (non-TNFi) are scarce. This study assessed the 4-years golimumab retention in patients with rheumatic diseases when used after discontinuation of non-TNFi. METHODS Adults with rheumatoid arthritis (RA; n = 72), psoriatic arthritis (PsA; n = 30) or axial spondyloarthritis (axSpA; n = 23) who initiated golimumab after discontinuation of non-TNFi from the Spanish registry of biological drugs (BIOBADASER) were analyzed retrospectively. The retention rate (drug survival or persistence) of golimumab up to 4 years was evaluated. RESULTS The golimumab retention rate was 60.7% (51.4-68.8) at year 1, 45.9% (36.0-55.2) at year 2, 39.9% (29.8-49.7) at year 3 and 33.4% (23.0-44.2) at year 4. Retention rates did not differ significantly whether golimumab was used as second, third, or fourth/subsequent line of therapy (p log-rank = 0.462). Golimumab retention rates were higher in axSpA or PsA patients than in RA patients (p log-rank = 0.002). When golimumab was administered as third or fourth/subsequent line, the 4-years retention rate after discontinuation of non-TNFi was similar to that after discontinuation of TNFi. CONCLUSION In patients who discontinued non-TNFi, most of whom received golimumab as third/subsequent line of therapy, one-third of patients remained on golimumab at year 4. Retention rates were higher in patients with axSpA and PsA than in those with RA.
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Affiliation(s)
- Manuel Pombo-Suárez
- Department of Rheumatology, Hospital Universitario de Santiago de Compostela, Rúa da Choupana, S/N, 15706, Santiago de Compostela, A Coruña, Spain.
| | - Daniel Seoane-Mato
- Clinical Research Unit, Spanish Society of Rheumatology (SER), Madrid, Spain
| | - Federico Díaz-González
- Department of Rheumatology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
- Department of Internal Medicine, Dermatology and Psychiatry, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
- Instituto de Tecnologías Biomédicas (ITB), Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | | | | | | | - Isabel Castrejón
- Department of Rheumatology, Gregorio Marañón University Hospital, Madrid, Spain
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Pombo-Suárez M, Sanchez-Piedra C, Ruiz-Montesino D, Diaz-Torne C, Jovaní V, Cea-Calvo L, Castrejón I. Retention of golimumab treatment following discontinuation of non-TNF inhibitors in patients with inflammatory rheumatic diseases: An analysis of the Spanish BIOBADASER registry. Musculoskeletal Care 2021; 20:403-407. [PMID: 34668303 DOI: 10.1002/msc.1595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/02/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Manuel Pombo-Suárez
- Servicio de Reumatología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | - Cesar Diaz-Torne
- Servicio de Reumatología, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - Vega Jovaní
- Servicio de Reumatología, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Isabel Castrejón
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
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