medwireNews: Clinical remission and normal physical function are “achievable goals” when using a treat-to-target strategy in older people with late-onset rheumatoid arthritis (RA), but not all patients are not able to adhere to this strategy, Japanese research shows.
Furthermore, non-adherence significantly reduces the likelihood of achieving low disease activity (LDA), report Takahiko Sugihara (Tokyo Medical and Dental University) and colleagues in Rheumatology.
Their study included 197 methotrexate-naïve people with late-onset RA (≥60 years old, mean 74 years) and moderate-to-high disease activity who were following a treat-to-target strategy targeting LDA.
At baseline, 79.7% of participants were given methotrexate, 24.9% were given other conventional DMARDs, 34.0% were given glucocorticoids, 2.5% were given tumor necrosis factor inhibitors, and 0.5% were given tocilizumab.
Over the course of the 3-year observation period, 84.7% of patients received methotrexate, 34.0% glucocorticoids with DMARDs, and 41.6% biologic DMARDs.
The researchers found that treatment could not be intensified according to the treat-to-target strategy on at least one occasion in 35.0% of participants, due to either comorbidity or patient choice. One failure was recorded in 16.8%, while two, three, or four or more failures were recorded in 9.6%, 5.1%, and 3.0%, respectively.
At 3 years, individuals adhering to treat-to-target were significantly more likely than non-adherent individuals to achieve SDAI LDA (<11.0 points; 84.4 vs 58.0%), SDAI remission (<3.2 points; 57.8 vs 34.8%), and to have a HAQ-DI of 0.5 points or lower (70.3 vs 43.5%).
They were also significantly less likely to have clinically-relevant radiographic progression between weeks 0 and 52 (21.5 vs 46.0%) and weeks 52 and 104 (1.8 vs 10.0%).
Serious adverse events (SAEs) occurred in 31.0% of patients, with infections requiring hospitalization, bone fractures, deterioration of RA lung disease, malignancy, and cardiovascular disease occurring at rates of 5.05, 2.99, 2.25, 2.06, and 1.87 cases per 100 person–years, respectively.
However, after adjusting for factors including comorbidity and mean baseline SDAI, Sugihara and team found that use of neither methotrexate, biologic DMARDs, nor glucocorticoids was associated with an increased risk for SAEs.
The authors conclude that although the treat-to-target intervention was associated with an “acceptable safety profile” and allowed some participants to achieve clinical remission and normal physical function, “[p]hysicians will always need to strike a balance between benefits and risks of treatment intensification for elderly patients.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group