UNASSIGNED: Treatment was adjusted to target low disease activity with conventional synthetic DMARDs followed by biologic DMARDs (bDMARDs) in LORA ≥75 years (n = 98, mean age 80.0 years) and LORA <75 years (n = 99) with moderate-high disease activity. Achievement of Simplified Disease Activity Index (SDAI) remission at week 156 by non-responder imputation analysis was evaluated as a primary outcome.
UNASSIGNED: LORA ≥75 years had more comorbidities than LORA <75 years, but SDAI and ACPA positivity were similar at baseline. Of the LORA ≥75 years, 70.4% started MTX and 34.1% and 37.1% received a bDMARD at week 52 and 156, respectively (very similar to the LORA <75 years). Glucocorticoid use was more frequent in the LORA ≥75 years than in the LORA <75 years. Comorbidities/adverse events more frequently contributed to the reasons for non-adherence to T2T in the LORA ≥75 than in the LORA <75. At week 156, 32.7% of the LORA ≥75 and 66.7% of the LORA <75 achieved SDAI remission (P < 0.001). The cumulative incidence of serious adverse events (SAEs) over 156 weeks was 42.8% in the LORA ≥75 and 22.1% in the LORA <75. Multivariable analysis indicated an increased risk of SDAI non-remission at week 156 in the LORA ≥75 [odds ratio 2.82 (95% CI 1.29. 6.14)] after adjusting for comorbidities at baseline, non-adherence to T2T and SAEs.
UNASSIGNED: It was more difficult to achieve remission in the LORA ≥75 patients than in the LORA <75 patients due to both poor treatment response and safety issues.
■调整治疗目标为低疾病活动度,采用常规合成DMARDs,然后在LORA≥75岁(n=98,平均年龄80.0岁)和LORA<75岁(n=99)中高疾病活动度的生物DMARDs(bDMARDs)。通过无反应者归因分析在第156周实现的简化疾病活动指数(SDAI)缓解被评估为主要结果。
■LORA≥75岁的合并症比LORA<75岁的合并症多,但基线时SDAI和ACPA阳性相似.LORA≥75岁,70.4%开始MTX,34.1%和37.1%分别在第52周和第156周接受bDMARD(与LORA<75年非常相似)。糖皮质激素的使用在LORA≥75岁时比LORA<75岁时更频繁。与LORA<75的患者相比,合并症/不良事件更频繁地导致不遵守T2T的原因。在第156周,32.7%的LORA≥75和66.7%的LORA<75达到SDAI缓解(P<0.001)。在156周内严重不良事件(SAE)的累积发生率在LORA≥75时为42.8%,在LORA<75时为22.1%。多变量分析表明,LORA≥75患者在第156周SDAI未缓解的风险增加[比值比2.82(95%CI1.29。6.14)]调整基线合并症后,不遵守T2T和SAE。
■由于治疗反应差和安全性问题,LORA≥75患者比LORA<75患者更难实现缓解。