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Rheumatology Advance Access published online on October 7, 2009
Rheumatology, doi:10.1093/rheumatology/kep291
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Response of elderly patients with rheumatoid arthritis to methotrexate or TNF inhibitors compared with younger patients

Marcus D. Köller1, Daniel Aletaha1, Julia Funovits1, Aileen Pangan2, Daniel Baker3 and Josef S. Smolen1

1Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria, 2Abbott Laboratories, Abbott Park, IL and 3Centocor, Malvern, PA, USA.

Correspondence to: Marcus D. Koeller, Department of Rheumatology/Internal Medicine III, General Hospital-Medical University of Vienna, Waehringer G. 18-20, A-1090 Vienna, Austria. E-mail: marcus.koeller{at}meduniwien.ac.at


  Abstract

Objective. To compare the efficacy of MTX and MTX+TNF inhibitors (TNFis) in elderly patients with RA with that in patients of younger age.

Methods. Data from two large, randomized, controlled, double-blind trials in patients with early RA using adalimumab or infliximab+MTX or MTX alone were obtained and pooled. Composite disease activity indices were calculated at baseline and 1 year of treatment, and compared in groups of patients classified by quartiles of age with the highest age group comprising 61–82 years using analysis of variance or Kruskal–Wallis test.

Results. Across all age quartiles, improvement on MTX was similar with respect to changes of composite disease activity indices, assessment of physical function and X-ray progression. Likewise, TNFi+MTX had similar effects across all age groups, but the effects of the combination were more profound than those of MTX monotherapy. Also in 10% of the patients with the highest age, primarily septuagenarians, improvement was seen to a similar degree as in the younger ones.

Conclusions. Responsiveness of elderly patients with RA to MTX or TNFi+MTX is similar to that observed in patients of younger age.

KEY WORDS: Rheumatoid arthritis, Methotrexate, Tumour necrosis factor, Treatment response, Elderly

Submitted 4 June 2009; revised version accepted 6 August 2009.
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