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Sicherheit der Rheumatherapie im Alter

Safety of antirheumatic drug treatment in the elderly

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Zusammenfassung

Der Anteil an geriatrischen Patienten wird auch im Krankengut des Rheumatologen größer, wofür in erster Linie der demographischen Wandel und die im Zuge besserer Behandlungsmöglichkeiten geringere Mortalität verantwortlich sind. Die medikamentöse Behandlung älterer Rheumapatienten bringt jedoch spezielle Probleme mit sich. So weist diese Altersgruppe pharmakokinetische Besonderheiten auf, außerdem führen häufig vorhandene Multimorbidität und Multimedikation zu vermehrten Interaktionsrisiken und schlechterer Adhärenz. Gleichwohl gelten für diese Patienten die gleichen Therapieprinzipien und -ziele wie für die jüngere Klientel. Hier die richtige Balance zu finden, fordert vom Rheumatologen Fingerspitzengefühl bei der Wahl der in jedem einzelnen Fall bestgeeigneten Medikamente. Keineswegs sollte die Angst vor vermeintlich größeren Risiken dazu führen, dass Patienten dieses Alters nicht adäquat versorgt werden – ein Sachverhalt, der leider durch eine Reihe von Untersuchungen nahegelegt wird.

Abstract

Mainly due to the general demographic changes and decreasing mortality in rheumatic diseases based on therapeutic progress, the proportion of older patients treated by rheumatologists is growing. Drug treatment in the elderly, however, harbors certain risks including age-specific pharmacokinetic features and high rates of multimorbidity and polypharmacy resulting in a risk of drug interactions and adherence problems. Nevertheless, older patients suffering from rheumatic diseases ought to be treated with the same intensity and same targets as the younger counterparts. Bearing all these facts in mind it is a balancing act for rheumatologists to find an optimal treatment for the individual elderly patient. Fear of risks should not lead to hesitant use of drugs leaving these patients alone with treatment deficits, as some studies have suggested.

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Literatur

  1. Alivernini S, Mazzotta D, Zoli A, Ferraccioli G (2009) Leflunomide treatment in elderly patients with rheumatoid or psoriatic arthritis. Drugs Aging 26:395–402

    Article  CAS  PubMed  Google Scholar 

  2. Bathon JM, Fleischmann RM, Heijde DM van der et al (2006) Safety and efficacy of etanercept treatment in elderly subjects with rheumatoid arthritis. J Rheumatol 33:234–243

    CAS  PubMed  Google Scholar 

  3. Bernatsky S, Ehrmann-Feldman D (2008) Discontinuation of methotrexate therapy in older patients with newly diagnosed rheumatoid arthritis. Drugs Aging 25:879–884

    Article  CAS  PubMed  Google Scholar 

  4. Chan J, Sanders DC, Du L, Pillans PI (2004) Leflunomide-associated pancytopenia with or without methotrexate. Ann Pharmacother 38:1206–1211

    Article  PubMed  Google Scholar 

  5. Christensen AM, Thagaard MS, Stentoft J (2013) Wrong administration of methotrexate can lead to fatal haematological complications in elderly patients. Ugeskr Laeger 175:435–436

    PubMed  Google Scholar 

  6. Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41

    Article  CAS  PubMed  Google Scholar 

  7. Cottone M, Kohn A, Daperno M et al (2011) Advanced age is an independent risk factor for severe infections and mortality in patients given anti – tumor necrosis factor therapy for inflammatory bowel disease. Clin Gastroenterol Hepatol 9:30–35

    Article  CAS  PubMed  Google Scholar 

  8. Delafuente JC (2003) Understanding and preventing drug interactions in elderly patients. Crit Rev Oncol Hematol 48:133–143

    Article  PubMed  Google Scholar 

  9. Del Rincon I, Battafarano DF, Restrepo JF et al (2013) Glucocorticoid dose thresholds associated with all-cause and cardiovascular mortality in rheumatoid arthritis. Arthritis Rheum. doi:10.1002/art.38210

  10. Diaz-Borjon A (2009) Guidelines for the use of conventional and newer disease-modifying antirheumatic drugs in elderly patients with rheumatoid arthritis. Drugs Aging 26:273–293

    Article  CAS  PubMed  Google Scholar 

  11. Dixon WG, Watson K, Lunt M et al (2007) Reduction in the incidence of myocardial infarction in patients with rheumatoid arthritis who respond to anti-tumor necrosis factor alpha therapy: results from the British Society for Rheumatology Biologics Register. Arthritis Rheum 56:2905–2912

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Dixon WG, Abrahamowicz M, Beauchamp ME et al (2012) Immediate and delayed impact of oral glucocorticoid therapy on risk of serious infection in older patients with rheumatoid arthritis: a nested case – control analysis. Ann Rheum Dis 71:1128–1133

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Doggrell SA (2010) Adherence to medicines in the older-aged with chronic conditions. Drugs Aging 27:239–254

    Article  PubMed  Google Scholar 

  14. Dougados M, Soubrier M, Antunez A et al (2014) Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA). Ann Rheum Dis 73:62–68

    Article  PubMed Central  PubMed  Google Scholar 

  15. Drosos AA (2003) Methotrexate intolerance in elderly patients with rheumatoid arthritis. What are the alternatives? Drugs Aging 20:720–736

    Article  Google Scholar 

  16. Feugier P, Van Hoof A, Sebban C et al (2005) Long-term results of the R-CHOP study in the treatment of elderly patients with diffuse large B-cell lymphoma: a study by the Groupe d’Etude des Lymphomes de l’Adulte. J Clin Oncol 23:4117–4126

    Article  CAS  PubMed  Google Scholar 

  17. Fiehn C (2006) Der multimorbide ältere Rheumapatient. Z Rheumatol 65:472–481

    Article  CAS  PubMed  Google Scholar 

  18. Fried LP, Tangen CM, Walston J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146–M156

    Article  CAS  PubMed  Google Scholar 

  19. Harrold L, Reed G, Saunders K et al (2012) Patient and provider factors associated with compliance with rheumatoid arthritis treatment recommendations. Ann Rheum Dis 71(Suppl 3):461

    Google Scholar 

  20. Harrold LR, Briesbacher BA, Peterson D et al (2013) Cost-related medication nonadherence in older rheumatoid arthritis patients. J Rheumatol 40:137–143

    Article  PubMed  Google Scholar 

  21. Hirshberg B, Muszkat M, Schlesinger O, Rubinow A (2000) Safety of low dose methotrexate in elderly patients with rheumatoid arthritis. Postgrad Med J 76:787–789

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Hopkins AC, Martinez-Marti M, Reed GW et al (2013) Effectiveness of TNF-a‘ inhibitor therapy does not differ between elderly and younger patients with rheumatoid arthritis: results from the corrona registry. Arthritis Rheum 65(Suppl):S608

    Article  Google Scholar 

  23. Hughes CM (2004) Medication non-adherence in the elderly. Drugs Aging 21:793–811

    Article  PubMed  Google Scholar 

  24. Huscher D, Thiele K, Gromnica-Ihle E et al (2009) Dose-related patterns of glucocorticoid-induced side effects. Ann Rheum Dis 68:1119–1124

    Article  CAS  PubMed  Google Scholar 

  25. Huscher D, Sengler C, Gromnica-Ihle E et al (2013) Clinical presentation, burden of disease and treatment in young-onset and late-onset rheumatoid arthritis: a matched-pairs analysis taking age and disease duration into account. Clin Exp Rheumatol 31:256–262

    PubMed  Google Scholar 

  26. Köller MD, Aletaha D, Funovits J et al (2009) Response of elderly patients with rheumatoid arthritis to methotrexate or TNF inhibitors compared with younger patients. Rheumatology 48:1575–1580

    Article  PubMed  Google Scholar 

  27. Krüger K (2012) Medikamentöse Interaktionen in der Rheumatologie. Z Rheumatol 71:209–216

    Article  PubMed  Google Scholar 

  28. Lakomek HJ, Brabant T, Lakomek M, Lüttje D (2013) Multimorbidität bei älteren Rheumapatienten – Teil 2. Z Rheumatol 72:539–546

    Article  PubMed  Google Scholar 

  29. McElnay JC, McCallion CR (1998) Adherence and the elderly. In: Myers LB et al (Hrsg) Adherence to treatment in medical conditions. Harwood Acad. Publ., Amsterdam, S 223–253

  30. Ng B, Chu A, Khan MM (2013) A retrospective cohort study: 10-year trend of disease-modifying antirheumatic drugs and biological agents use in patients with rheumatoid arthritis at Veteran Affairs Medical Centers. BMJ Open 3:e002468. doi 10.1136/bmjopen-2012-002468

    Article  PubMed Central  PubMed  Google Scholar 

  31. Radovits BJ, Kievit W, Laan RFJM (2009) Tumour necrosis factor-a antagonists in the management of rheumatoid arthritis in the elderly. Drugs Aging 26:647–664

    Article  CAS  PubMed  Google Scholar 

  32. Ranganath VK, Maranian P, Elashoff DA et al (2013) Comorbidities are associated with poorer outcomes in community patients with rheumatoid arthritis. Rheumatology 52:1809–1817

    Article  PubMed  Google Scholar 

  33. Saxena A, Balaramnavar VM, Hohlfeld T, Saxena AK (2013) Drug/drug interaction of common NSAIDs with antiplatelet effect of aspirin in human platelets. Eur J Pharmacol 721:215–224

    Article  CAS  PubMed  Google Scholar 

  34. Schiff MH, Yu EB, Weinblatt ME et al (2006) Long-term experience with etanercept in the treatment of rheumatoid arthritis in elderly and younger patients: patient-reported outcomes from multiple controlled and open-label extension studies. Drugs Aging 23:167–178

    Article  CAS  PubMed  Google Scholar 

  35. Spagnoli A, Ostino G, Borga AD et al (1989) Drug compliance and unreported drugs in the elderly. J Am Geriatr Soc 37:619–624

    CAS  PubMed  Google Scholar 

  36. Strangfeld A, Gäwert L, Bussmann A et al (2009) Therapie mit Biologika bei älteren Patienten mit rheumatoider Arthritis – Ergebnisse aus dem deutschen Biologika-Register RABBIT. Akt Rheumatol 34:291–298

    Article  Google Scholar 

  37. Tutuncu Z, Reed G, Kremer J, Kavanaugh A (2006) Do patients with older-onset rheumatoid arthritis receive less aggressive treatment? Ann Rheum Dis 65:1226–1229

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  38. Wehling M, Burkhardt H (2011) Arzneitherapie für Ältere. Springer Verlag Heidelberg, Berlin, New York

  39. Westhoff G, Weber C, Zink A (2006) Komorbidität bei früher rheumatoider Arthritis. Z Rheumatol 65:487–496

    Article  CAS  PubMed  Google Scholar 

  40. Wiesner G, Grimm J, Bittner E (2003) Multimorbidität in Deutschland. Stand – Entwicklung – Folgen. Robert-Koch-Institut, Berlin, S 3–194

  41. Witham MD (2011) Drug trials and older people – time to embrace the complexity of age. Drugs Aging 28:679–680

    Article  PubMed  Google Scholar 

  42. Zulman DM, Sussman JB, Chen X et al (2011) Examining the evidence: a systematic review of the inclusion and analysis of older adults in randomized controlled trials. J Gen Intern Med 7:783–790

    Article  Google Scholar 

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Interessenkonflikt

Die Autoren weisen auf folgende Beziehungen hin: K. Krüger: Vorträge und/oder Beratungstätigkeit für die Firmen Abbvie, Bristol Myers Squibb, Medac, MSD, Pfizer, Roche, UCB. Für A. Strangfeld und C. Kneitz liegt kein Interessenkonflikt vor. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Rheumatologisches Praxiszentrum, St. Bonifatius Str. 5, 81541, München, Deutschland

    K. Krüger

  2. Deutsches Rheuma-Forschungszentrum (DRFZ), Berlin, Deutschland

    A. Strangfeld

  3. Klinik für Innere Medizin II, Rheumatologie/Immunologie, Rheumazentrum, Klinikum Südstadt Rostock, Rostock, Deutschland

    C. Kneitz

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  1. K. Krüger
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  2. A. Strangfeld
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  3. C. Kneitz
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Correspondence to K. Krüger.

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Krüger, K., Strangfeld, A. & Kneitz, C. Sicherheit der Rheumatherapie im Alter. Z. Rheumatol. 73, 244–250 (2014). https://doi.org/10.1007/s00393-013-1245-3

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  • DOI: https://doi.org/10.1007/s00393-013-1245-3

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