2018 Volume 37 Issue 2 Pages 77-85
Objective: The importance of treatment for elderly patients with rheumatoid arthritis (RA) has increased because of a growing number of such patients, in addition to the difficulty of treating the aforementioned disease in an aging population. Lung disease is a common extra-articular manifestation of RA, and interstitial lung disease (ILD) is the most important, as it is substantially associated with increased morbidity and mortality. The aim of this study was to evaluate the safety and efficacy of abatacept (ABT), a CD80 and CD86 inhibitor which interrupts cell signaling for T-cell activation, and to verify whether dose reduction and discontinuation of concomitant methotrexate (MTX) and glucocorticoids (GCs) are possible for elderly patients over 70-years-old with lung disease.
Methods: A retrospective chart review was undertaken. ABT treatment was initiated for 106 patients with RA between April 2008 and January 2014, inclusive. Twenty-four patients were over 70-years-old and had lung disease diagnosed by computed tomography (CT) analysis. Forty-five percent of the patients had chronic kidney disease. The efficacy, safety and concomitant MTX and GCs administration were assessed.
Results: Continuation rate and DAS28ESR remission rates at 3-years for the 24 patients was 54.2%. Discontinuation of MTX and GCs was possible in 38.5% and 58.8% of the patients, respectively, without decreasing the remission rate. No patients had abatacept discontinued due to infection among the cohort of 24 patients over 70-years-old with lung disease for the 3-year period.
Conclusion: ABT appeared safe for long-term use in elderly patients with RA and lung disease. Furthermore, ABT therapy may allow the reduction or even discontinuation of concomitant MTX and GCs without seemingly affecting remission rates for RA.
