medwireNews: Older people with rheumatoid arthritis (RA) are not at increased risk for hospitalization with infection when receiving targeted therapy with biologics or Janus kinase (JAK) inhibitors rather than methotrexate, Japanese researchers report.
Masayoshi Harigai (Tokyo Women’s Medical University School of Medicine) and colleagues used Japanese insurance claims data to identify 22,696 individuals with RA who began a biologic, JAK inhibitor, or methotrexate between 2008 and 2018. During this period there were 1811 hospitalized infections among 1467 patients who were followed up for a median of 26 months.
The researchers calculated that the overall incidence of hospitalization with infection was 3.2 cases per 100 patient–years in people aged 16 to 64 years, 5.0 cases per 100 patient–years among those age 65 to 74 years, and 10.1 cases per 100 patient–years in people aged 75 years and older.
Medication use varied significantly among the different age groups during the follow-up period with rates generally higher among the younger age groups, particularly for tumor necrosis factor inhibitors. A notable exception was abatacept, which was more often used among the oldest patients than among their younger counterparts. Oral corticosteroid use also increased significantly with age.
After adjusting for patient characteristics and RA medication use, the investigators found that the risk for hospitalized infection was significantly higher with targeted therapy use than with methotrexate use in the group aged 16 to 64 years, at an odds ratio (OR) of 1.33.
There was no significant difference in hospitalized infection risk between the two treatment types for people aged 65 to 74 years, but the risk was significantly lower, at an OR of 0.73, with targeted therapy than with methotrexate among people aged 75 years and older.
And the results were similar when the researchers excluded JAK inhibitors from the targeted therapy group.
Writing in Arthritis Research & Therapy, Harigai and co-authors say their findings indicate that targeted therapy “can be provided safely to [older] patients with RA with careful risk management and appropriate adjustment for treatments and that treatment strategy may differ across the age groups.”
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