Efficacy and Safety of Etanercept in Elderly Patients with Rheumatoid Arthritis: A Post-Hoc Analysis of Randomized Controlled Trials

Abstract

Background

Elderly individuals are disproportionately affected by rheumatoid arthritis (RA), but few studies have addressed the efficacy and safety of treatments in this population.

Objective

Our objective was to assess the efficacy and safety of etanercept in elderly patients (aged ≥ 65 years) with RA.

Methods

The efficacy analysis was a post hoc analysis of data from the open-label period of three phase IV clinical trials of etanercept for RA. Least squares (LS) change from baseline (cfb) in 28-joint Disease Activity Score (DAS28), Health Assessment Questionnaire Disability Index (HAQ-DI), and modified Total Sharp Scores (mTSS) were analyzed by age (< 65 vs. ≥ 65 years) for each study. The safety analyses were of data pooled from the double-blind, placebo-controlled periods of 19 phase I–IV randomized studies of etanercept in patients with RA. The percentage occurrence of adverse events (AEs) in placebo- and etanercept-treated patients was analyzed by age (< 65 vs. ≥ 65 years).

Results

There were no significant differences in LS mean cfb in DAS28 or mTSS between the two age groups. LS mean cfb in HAQ-DI scores was consistently lower in elderly than in non-elderly patients, although significant differences were not observed in all trials. Overall, AE occurrence was higher in elderly than non-elderly patients, regardless of treatment. In etanercept-treated patients, there were small yet statistically significant increases in the occurrence of congestive heart failure, serious infections, and non-melanoma skin cancers in elderly versus non-elderly patients. For most AEs, occurrence did not significantly differ between elderly and non-elderly patients.

Conclusion

Overall, there were no substantial differences in the efficacy or safety of etanercept between elderly and non-elderly patients with RA.

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Correspondence to Christopher J. Edwards.

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Funding

This study was funded by Pfizer. Medical writing support was provided by Lorna Forse, PhD, of Engage Scientific Solutions and was funded by Pfizer.

Conflict of Interest

Professor Edwards has received honoraria for advisory boards and speakers’ bureau and research support from AbbVie, BMS, Biogen, Celgene, Fresenius, Janssen, Lilly, Mundipharma, Pfizer, MSD, Novartis, Roche, Samsung, Sanofi, and UCB. Ms. Roshak was an employee of Pfizer at the time of data generation and manuscript initiation. Dr. Thakur is an employee of RegSafe Consulting Limited and was contracted by Pfizer in connection with the development of the manuscript. Mr. Pedersen, Dr. Borlenghi, and Dr. Curiale are employees of and own stock in Pfizer. Dr. Bukowski, Ms. Jones, and Dr. Marshall were employees of Pfizer at the time of data generation and manuscript development and own stock in Pfizer.

Ethical Approval

As a non-interventional study, ethical approval was not required for this analysis. This article does not contain any studies with human participants or animals performed by any of the authors.

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Edwards, C.J., Roshak, K., Bukowski, J.F. et al. Efficacy and Safety of Etanercept in Elderly Patients with Rheumatoid Arthritis: A Post-Hoc Analysis of Randomized Controlled Trials. Drugs Aging 36, 853–862 (2019). https://doi.org/10.1007/s40266-019-00691-8

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