Drug Survival Time of First bDMARD Similar Between Late-Onset, Early-Onset RA

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New research has found that drug survival times of the first biologic disease-modifying anti-rheumatic drugs (bDMARDs) were similar between patients with late-onset and early-onset rheumatoid arthritis (RA), although patients with early-onset RA were treated with bDMARDs at a greater extent.¹

“RA is a chronic, incurable and progressive disease; therefore, the majority of patients require lifelong treatments. While disease remission remains the ideal treatment goal in RA, achieving remission can be often challenging, particularly among late-onset RA patients,” lead investigator Helana Jeries, Rheumatology Unit, Galilee Medical Center, Nahariya, and Azrieli Faculty of Medicine, Bar-Ilan University, Israel, and colleagues wrote.¹

Jeries and colleagues analyzed data from the medical records of Leumit healthcare services in a population-based cohort study including all eligible patients with RA (n = 3814) between 2000 and 2017. They compared data from patients with late-(n = 1007; 26.4%) and early-onset (n = 2807; 73.6%) RA.¹

The investigators found that bDMARDs were used more often by patients with early-onset RA (n = 474; 16.9%) than by patients with late-onset RA (n = 79; 7.8%; P <.001). The most common first-line biological therapy was etanercept (n = 294; 7.7%) followed by adalimumab (n = 197; 5.2%).

In the early-onset cohort, etanercept was associated with the longest drug survival time on the first biologic, with a mean time of 948 ± 79 days. In the late-onset cohort, adalimumab (mean survival duration, 1126 ± 337 days) and infliximab (mean survival duration, 1124 ± 451 days) were associated with the longest drug survival time.

The investigators did not observe any differences in drug survival on the first bDMARD between patients with late-onset and early-onset RA, except for abatacept (early-onset mean survival, 647 ± 147 days; late onset mean survival, 110 ± 10 days; P = .04) and golimumab (early-onset mean survival, 556 ± 133 days; late onset mean survival, 28 ± 0 days; P <.01), which were longer among the early-onset group. There was also no significant difference in the time interval from RA diagnosis to the first biological therapy given between the early- (1668.56 days) and late-onset cohorts (1453.29 days; P = .111).¹

“Concerns about the development of adverse events in the late-onset group as a result of age-related changes in drug metabolism and the presence of comorbid illnesses are increasingly challenging due to the increasing prevalence of RA in older patients. However, late-onset RA patients are still inadequately represented in RA clinical trials,” Jeries and colleagues wrote.¹

Although late-onset RA remains an understudied population, a recent broad study of patients with RA elucidated the burden of the disease, revealing higher health care costs and suboptimal quality in life in adults in the United States with RA.²

Investigators found that compared with participants without RA, patients with RA had had significantly higher total annual healthcare expenditures. Specifically, the RA group had an average expenditures of prescription medication of $2,319.15 (95% CI [1,408.39–3,229.90]; P < .001) higher than that for the non-RA group. Participants with RA also had lower physical component summary scores than the non-RA group, with an adjusted marginal difference (AMD) of 4.78 (95% CI, 3.47–6.09) and mental component summary scores (AMD, −0.84 [95% CI, −2.18 to 0.50]).²

REFERENCES

1. Jeries H, Daood R, Hijazi B, et al. Drug Survival on First Biologic Therapy Among Late-Onset Rheumatoid Arthritis Patients Compared to Early-Onset Patients: A Population-Based Cohort Study. Musculoskeletal Care, 2024 (22): e1928. doi: 10.1002/msc.1928
2. Huang Y, Li J, Agarwal SK. Economic and Humanistic Burden of Rheumatoid Arthritis: Results From the US National Survey Data 2018–2020. ACR Open Rheumatol. Published online August, 2024. doi: 10.1002/acr2.11728