Objectives

This study aimed to analyse the clinical features and outcomes of and reasons for discontinuing tumour necrosis factor (TNF) inhibitor therapy in older patients with ankylosing spondylitis (AS).

Methods

Data were extracted from the nationwide Korean College of Rheumatology Biologics registry. Clinical variables and outcomes were compared, and drug retention rate was evaluated.

Results

Among 1524 patients with AS treated with TNF inhibitors, 306 were aged ≥ 50 years (‘older patients’). Fewer patients were male, the incidence of hypertension and diabetes was higher (all p < 0.001), and the proportion of peripheral arthritis (35.6 vs. 27.1%), Ankylosing Spondylitis Disease Activity Score‒erythrocyte sedimentation rate (4.0 ± 1.1 vs. 3.6 ± 1.0), and Bath Ankylosing Spondylitis Functional Index (4.2 ± 2.6 vs. 3.3 ± 2.5) were all higher in older patients. Although the drug retention rate was lower (log-rank p = 0.018) and lack of efficacy and adverse events were more frequent in older patients (both p < 0.001), drug retention rates were not different after propensity score matching (log-rank p = 0.23). Improvements in disease activity and manifestations were comparable between groups, except for the incidence of peripheral arthritis, which decreased significantly less in older patients over 3 and 5 years.

Conclusion

Improvements in disease-related clinical factors and drug retention rates were not different between older and younger patients with AS receiving TNF inhibitors. However, the incidence of adverse events was higher in older patients.

中文翻译：

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强直性脊柱炎老年患者中 TNF 抑制剂的临床特征和药物保留：来自 KOBIO 登记处的结果

目标

本研究旨在分析老年强直性脊柱炎 (AS) 患者停止肿瘤坏死因子 (TNF) 抑制剂治疗的临床特征、结果和原因。

方法

数据来自韩国全国风湿病学生物制品学院登记处。比较临床变量和结果，并评估药物保留率。

结果

在接受 TNF 抑制剂治疗的 1524 名 AS 患者中，306 名年龄≥ 50 岁（“老年患者”）。男性患者较少，高血压和糖尿病发病率较高（均p < 0.001），外周关节炎比例（35.6 vs. 27.1%）、强直性脊柱炎疾病活动评分-红细胞沉降率（4.0 ± 1.1 vs. 3.6） ± 1.0) 和 Bath 强直性脊柱炎功能指数 (4.2 ± 2.6 vs. 3.3 ± 2.5) 在老年患者中均较高。尽管药物保留率较低（对数秩p = 0.018）并且在老年患者中缺乏疗效和不良事件更常见（均p < 0.001），但在倾向评分匹配后药物保留率没有差异（对数秩p= 0.23)。各组之间疾病活动和表现的改善是可比的，除了外周关节炎的发生率，在 3 年和 5 年以上的老年患者中，外周关节炎的发生率显着降低。

结论

接受 TNF 抑制剂的老年和年轻 AS 患者在疾病相关临床因素和药物保留率方面的改善没有差异。然而，老年患者的不良事件发生率较高。