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

Update on Safety in Older Patients

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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.

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Acknowledgements

No sources of funding were used to assist in the preparation of the manuscript. The authors have no potential conflicts of interest that are directly relevant to the contents of the manuscript.

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Authors and Affiliations

  1. Department of Rheumatology, Dijon University Hospital, Dijon, France

    Paul Ornetti, Hélène Chevillotte, Amal Zerrak &  Jean Francis Maillefert

  2. University of Burgundy, Dijon, France

    Paul Ornetti &  Jean Francis Maillefert

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  1. Paul Ornetti
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  2. Hélène Chevillotte
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  3. Amal Zerrak
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  4. Jean Francis Maillefert
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Correspondence to Jean Francis Maillefert.

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Ornetti, P., Chevillotte, H., Zerrak, A. et al. Anti-Tumour Necrosis Factor-α Therapy for Rheumatoid and Other Inflammatory Arthropathies. Drugs Aging 23, 855–860 (2006). https://doi.org/10.2165/00002512-200623110-00001

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