Older patients with rheumatoid arthritis (RA) had worse safety and efficacy with biological agents but also had worse baseline disease activity, according to a recent study. A comprehensive, systematic search was conducted in major indexing databases using key terms for RA and each biological agent. Investigators randomized controlled trials and included observational studies of at least 6-month duration conducted in adult RA patients. Outcomes of interest were clinical efficacy and safety. They found:

• 24 studies (16 focusing on anti-TNF agents) representing 63,705 patients (24% were older) were included.
• Older RA patients had worse baseline RA disease activity, longer disease duration at the time of enrollment in the trial (14.4±3.6 vs 10.9±3.6 years), and higher steroid use (73.2% vs 64.7%) than younger.
• 5 out of 6 studies assessing anti-TNF agents showed worse efficacy outcomes in older patients.
• The pooled odds ratio (OR) of infection and adverse drug reactions with anti-TNF agents in older compared to young RA patients was OR 1.59 and 1.40, respectively.