Sunner Sanjot, Jones Britney, Jones C Allyson, Al Hamarneh Yazid N, Sadowski Cheryl, Maksymowych Walter P, Yacyshyn Elaine A
Faculty of Medicine & Dentistry, University of Alberta, MacKenzie Health Sciences Center, 2J2.00 Walter C, Edmonton, AB, T6G2R7, Canada.
Clin Rheumatol. 2025 Aug 12. doi: 10.1007/s10067-025-07615-5.
Rheumatoid arthritis (RA) is a chronic inflammatory condition with increasing prevalence, particularly in older adults. This study examined differences in prescribing patterns of biologic DMARDs (bDMARDs) between younger (< 65 years) and older (≥ 65 years) adults and explored factors influencing delays in therapy initiation.
A retrospective comparison of bDMARD use in younger (< 65 years) and older (≥ 65 years) adults who have RA was conducted using data from the Rheumatoid Arthritis Pharmacovigilance Program and Outcomes Research in Therapeutics (RAPPORT) registry. Disease activity was assessed using the Disease Activity Score (DAS28) and Health Assessment Questionnaire (HAQ). multivariable regression analysis was performed to explore factors associated with delayed bDMARD prescription.
Among 3411 patients, older adults experienced significantly longer delays in bDMARD initiation compared to younger patients (p < 0.0001). Older adults also demonstrated higher disease activity (HAQ: 1.75 vs. 1.48, DAS28: 5.95 vs. 5.49, both p < 0.0001) and elevated inflammatory markers. Regression analysis revealed that advanced age, comorbidity burden, smoking, and seropositivity were associated with delays in bDMARD initiation.
Despite evidence supporting bDMARD efficacy and safety, older RA patients face significant delays in therapy, leading to suboptimal disease control and increased adverse outcomes. Addressing age-related barriers to RA treatment is critical to improving equitable access. Further research is needed to investigate mechanisms underlying these disparities and assess the benefits of timely bDMARD initiation on long-term outcomes in older adults. Key Points • Older adults with rheumatoid arthritis experience significant delays in biologic therapy initiation compared to younger patients. • Addressing age-related treatment disparities is crucial for improving disease outcomes and quality of life. • Future research should investigate clinician hesitancy and patient barriers to timely biologic therapy initiation.
类风湿关节炎（RA）是一种患病率不断上升的慢性炎症性疾病，在老年人中尤为常见。本研究考察了年轻（<65岁）和年长（≥65岁）成年人在生物性改善病情抗风湿药（bDMARDs）处方模式上的差异，并探讨了影响治疗起始延迟的因素。
利用类风湿关节炎药物警戒计划和治疗结果研究（RAPPORT）登记处的数据，对患有RA的年轻（<65岁）和年长（≥65岁）成年人使用bDMARDs的情况进行回顾性比较。使用疾病活动评分（DAS28）和健康评估问卷（HAQ）评估疾病活动度。进行多变量回归分析以探讨与bDMARD处方延迟相关的因素。
在3411例患者中，与年轻患者相比，年长成年人在开始使用bDMARDs方面的延迟明显更长（p<0.0001）。年长成年人还表现出更高的疾病活动度（HAQ：1.75对1.48，DAS28：5.95对5.49，均p<0.0001）以及炎症标志物升高。回归分析显示，高龄、合并症负担、吸烟和血清学阳性与bDMARD起始延迟有关。
尽管有证据支持bDMARDs的疗效和安全性，但老年RA患者在治疗方面面临显著延迟，导致疾病控制不佳和不良后果增加。解决与年龄相关的RA治疗障碍对于改善公平获得治疗至关重要。需要进一步研究以调查这些差异背后的机制，并评估及时开始使用bDMARDs对老年人长期结局的益处。要点 • 与年轻患者相比，老年类风湿关节炎患者在生物治疗起始方面经历显著延迟。 • 解决与年龄相关的治疗差异对于改善疾病结局和生活质量至关重要。 • 未来研究应调查临床医生的犹豫态度和患者在及时开始生物治疗方面的障碍。
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