Scholarlink

Objective <p>Older adults with rheumatoid arthritis (RA) treated with biologic disease-modifying antirheumatic drugs (bDMARDs), including anti-TNFs, are at an increased risk of adverse effects. Current guidelines recommend de-escalating DMARDs for patients with low disease activity or remission to optimize the benefit-harm ratio of treatment. Our prior study found that two-thirds of older adults with RA de-escalated anti-TNFs yet real-world treatment courses after de-escalation in older adults are poorly understood. We aimed to describe real-world post-de-escalation treatment courses and identify factors associated with re-escalation.</p> Methods <p>We used 20% Medicare data from 2009 to 2022 to identify RA patients ≥ 66 years of age on anti-TNF therapy with de-escalation by cessation (&gt; 90-day gap) or by taper (&gt; 50% effective dose reduction), and at least one rheumatologist visits pre- and post-de-escalation (i.e., index date). Re-escalation was defined as restarting the same anti-TNF or another bDMARD or increasing the effective dose by &gt; 50% after de-escalation. Those without re-escalation were considered to have sustained de-escalation. Multivariable Cox proportional hazards regression models were used to identify factors associated with re-escalation, relative to sustained de-escalation.</p> Results <p>Among 949 beneficiaries who met inclusion criteria, the mean age was 75.1 years, 82.5% were female, and 41.9% had low-income subsidies (LIS). 38.4% sustained de-escalation, while 61.6% re-escalated treatment with a median time to re-escalation of 164 (IQR 113–301) days. In Cox analyses, re-escalation, compared to sustained de-escalation, was more likely among individuals who were Black, Hispanic/other, and with a lower comorbidity burden.</p> Conclusions <p>Nearly four in ten older adults with RA sustained de-escalation of anti-TNF, supporting the feasibility for selected individuals in routine practice. Most re-escalations occurred within six months, suggesting a need for closer follow-up early after de-escalation.</p> Clinical trial number <p>Not applicable.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Real-world treatment courses after anti-TNF de-escalation in older adults with rheumatoid arthritis: a medicare cohort study

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年4月11日

查看全文
  • Jiha Lee,
  • Jonathan Martindale,
  • Una E. Makris,
  • Julie P. W. Bynum

摘要

Objective

Older adults with rheumatoid arthritis (RA) treated with biologic disease-modifying antirheumatic drugs (bDMARDs), including anti-TNFs, are at an increased risk of adverse effects. Current guidelines recommend de-escalating DMARDs for patients with low disease activity or remission to optimize the benefit-harm ratio of treatment. Our prior study found that two-thirds of older adults with RA de-escalated anti-TNFs yet real-world treatment courses after de-escalation in older adults are poorly understood. We aimed to describe real-world post-de-escalation treatment courses and identify factors associated with re-escalation.

Methods

We used 20% Medicare data from 2009 to 2022 to identify RA patients ≥ 66 years of age on anti-TNF therapy with de-escalation by cessation (> 90-day gap) or by taper (> 50% effective dose reduction), and at least one rheumatologist visits pre- and post-de-escalation (i.e., index date). Re-escalation was defined as restarting the same anti-TNF or another bDMARD or increasing the effective dose by > 50% after de-escalation. Those without re-escalation were considered to have sustained de-escalation. Multivariable Cox proportional hazards regression models were used to identify factors associated with re-escalation, relative to sustained de-escalation.

Results

Among 949 beneficiaries who met inclusion criteria, the mean age was 75.1 years, 82.5% were female, and 41.9% had low-income subsidies (LIS). 38.4% sustained de-escalation, while 61.6% re-escalated treatment with a median time to re-escalation of 164 (IQR 113–301) days. In Cox analyses, re-escalation, compared to sustained de-escalation, was more likely among individuals who were Black, Hispanic/other, and with a lower comorbidity burden.

Conclusions

Nearly four in ten older adults with RA sustained de-escalation of anti-TNF, supporting the feasibility for selected individuals in routine practice. Most re-escalations occurred within six months, suggesting a need for closer follow-up early after de-escalation.

Clinical trial number

Not applicable.