Leading Article

Drugs & Aging

, Volume 23, Issue 11, pp 855-860

First online:

Anti-Tumour Necrosis Factor-α Therapy for Rheumatoid and Other Inflammatory Arthropathies

Update on Safety in Older Patients
  • Paul OrnettiAffiliated withDepartment of Rheumatology, Dijon University HospitalUniversity of Burgundy
  • , Hélène ChevillotteAffiliated withDepartment of Rheumatology, Dijon University Hospital
  • , Amal ZerrakAffiliated withDepartment of Rheumatology, Dijon University Hospital
  • , Jean Francis MaillefertAffiliated withDepartment of Rheumatology, Dijon University HospitalUniversity of Burgundy Email author 

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Abstract

Anti-tumour necrosis factor (TNF)-α represents a major advance in the treatment of rheumatoid arthritis (RA), ankylosing spondylitis and psoriatic arthritis. It is usually well tolerated, but a potential increase in the incidence of some infections in patients taking anti-TNFα agents has been reported.

Compared with younger people, elderly patients have more co-morbidities and are likely to be taking more medications. Moreover, the aging process induces an increase in the rate of infections. Nevertheless, in recent studies analysing the databases of etanercept trials, the normalised incidence of adverse events, serious adverse events, medically important infections and deaths was not increased in patients aged ≥65 years. However, these trials included patients who might have been healthier than elderly RA patients in the general population and therefore not truly representative. Conflicting results have been reported in several ‘real-life’ observational studies.

Taken together, the available data are reassuring for carefully selected populations, at least for etanercept, but it is not possible to claim that anti-TNFα agents do, or do not, pose a particular risk for the general population of older patients. Additional studies aiming at determining the safety and benefit-risk ratio of anti-TNFα agents in elderly patients are needed. In addition, since the benefit-risk ratio of anti-TNFα agents might be different in patients aged 65, 75 or >80 years, when possible, subgroup analysis might also be useful.