The operational definition of old age and impact on outcomes in DMARD-treated patients with rheumatoid arthritis: A systematic literature review

IF 4.6 2区医学 Q1 RHEUMATOLOGY Seminars in arthritis and rheumatism Pub Date : 2024-12-20 DOI:10.1016/j.semarthrit.2024.152607

Saskia P.M. Truijen , Jerome P.R. Schreurs , Annelies Boonen , Marloes van Onna

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Abstract

Objective

To systematically review operational definitions of old(er) age in rheumatoid arthritis (RA) patients and investigate differences in disease-modifying anti-rheumatic drug (DMARD) efficacy, safety and drug survival between young(er) and old(er) patients.

Methods

A systematic review was performed on studies conducting research in an old(er) RA patient population. Two reviewers independently performed data extraction and risk of bias assessment. Operational definitions of old(er) age were described using frequency statistics. For studies comparing effects of DMARDs, random effects meta-analyses estimated pooled odds ratios (ORs) of young(er) vs. old(er) patients reaching remission, experiencing adverse events (AEs) and discontinuing drug treatment due to unfavourable events.

Results

This review included 324 studies. The operational definition for old(er) age ranged from 40.0 to 77.3 years. The most frequent definition was 65 (45.1 %), followed by 60 years or older (20.4 %). Fifty-eight percent of studies reported no reason for using a specific age-threshold. Seventy-nine studies evaluated DMARD efficacy, safety and/or survival, with 37 eligible for meta-analysis. No statistically significant difference in reaching remission was observed between old(er) and young(er) patients (OR=0.76 (95 %-CI: 0.57–1.02)) (n = 11 studies). AEs and drug discontinuation were experienced more often in old(er) patients (OR=1.33 (95 %-CI: 1.01–1.74) (n = 19 studies) and OR=1.12 (95 %-CI: 1.02–1.23) (n = 25 studies), respectively).

Conclusion

Definitions of old(er) age vary across studies including RA patients. Old(er) age appears to affect DMARD safety and discontinuation. To ensure meaningful comparisons across studies, studies should justify the chosen definition and report and account for potential impacts of indicators of ageing, such as multimorbidity, polypharmacy, and geriatric syndromes.

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dmard治疗类风湿性关节炎患者老年的操作定义及其对预后的影响：一项系统的文献综述。

目的：系统回顾类风湿关节炎（RA）患者老年（er）年龄的操作定义，探讨年轻（er）和老年（er）患者抗风湿药物（DMARD）疗效、安全性和药物生存期的差异。方法：对在老年类风湿性关节炎患者人群中进行的研究进行系统综述。两名审稿人独立进行数据提取和偏倚风险评估。使用频率统计描述了老年（er）年龄的操作定义。对于比较dmard疗效的研究，随机效应荟萃分析估计了达到缓解、经历不良事件（ae）和因不良事件而停止药物治疗的年轻（er）与老年（er）患者的合并优势比（ORs）。结果：本综述纳入324项研究。老年（老年）年龄的操作定义范围从40.0岁到77.3岁。最常见的定义是65岁（45.1%），其次是60岁或以上（20.4%）。58%的研究报告没有理由使用特定的年龄阈值。79项研究评估了DMARD的疗效、安全性和/或生存期，其中37项研究符合meta分析的要求。老年（er）和年轻（er）患者在缓解方面无统计学差异（OR=0.76 (95% -CI: 0.57-1.02)）（n = 11项研究）。老年（er）患者更常发生ae和停药(OR=1.33 (95% -CI: 1.01-1.74) （n = 19项研究）和OR=1.12 (95% -CI: 1.02-1.23) （n = 25项研究）。结论：老年（er）年龄的定义在包括RA患者在内的研究中有所不同。老年似乎会影响DMARD的安全性和停药。为了确保研究间有意义的比较，研究应证明所选定义的合理性，并报告和解释老龄化指标的潜在影响，如多重发病、多种用药和老年综合征。

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来源期刊

Seminars in arthritis and rheumatism 医学-风湿病学

CiteScore

9.20

自引率

4.00%

发文量

176

审稿时长

46 days

期刊介绍： Seminars in Arthritis and Rheumatism provides access to the highest-quality clinical, therapeutic and translational research about arthritis, rheumatology and musculoskeletal disorders that affect the joints and connective tissue. Each bimonthly issue includes articles giving you the latest diagnostic criteria, consensus statements, systematic reviews and meta-analyses as well as clinical and translational research studies. Read this journal for the latest groundbreaking research and to gain insights from scientists and clinicians on the management and treatment of musculoskeletal and autoimmune rheumatologic diseases. The journal is of interest to rheumatologists, orthopedic surgeons, internal medicine physicians, immunologists and specialists in bone and mineral metabolism.