Infection is one of the primary concerns during treatment for rheumatoid arthritis (RA) in elderly patients. However, infection risk of patients with RA receiving targeted therapy (TT) including biological disease-modifying antirheumatic drugs (bDMARDs) and Janus kinase inhibitors (JAKIs) in elderly patients are scarce. The aim of this study was to compare the risk of hospitalized infection (HI) with TT versus methotrexate (MTX) therapy among young, elderly, and older elderly patients with RA. Using Japanese claims data, patients satisfying the following criteria were enrolled: (1) ≥ one ICD10 code for RA; (2) ≥ one prescription of MTX or TT (bDMARDs and JAKIs) between April 2008 and September 2018; and (3) ≥16 years old. We calculated the incidence rate (IR) of HI per 100 patient-years in the young, elderly, and older elderly groups (those aged 16–64, 65–74, and ≥75 years, respectively) and the IR ratio (TT vs. MTX) of HI. A logistic regression model was used to estimate the associations between HI and TT versus MTX in each group. The overall IR of HI per 100 patient-years (95% confidence interval) was 3.2 [2.9–3.5], 5.0 [4.6–5.4], and 10.1 [9.5–10.9] in the young, elderly, and older elderly groups, respectively. Concomitant use of MTX or immunosuppressive DMARDs with TT was less frequent in the elderly and older elderly groups. The adjusted odds ratio of TT vs. MTX for HI was 1.3 (1.0–1.7; p = 0.021), 0.79 (0.61–1.0; p = 0.084), and 0.73 (0.56–0.94; p = 0.015) in the young, elderly, and older elderly groups, respectively. The overall IR of HI was increased with age. The risk of HI under TT compared to MTX was not elevated in elderly and older elderly patients after adjusting for patients’ characteristics and concomitant treatments.

中文翻译：

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在老年类风湿关节炎患者中，靶向治疗与甲氨蝶呤相比住院感染风险未增加：一项回顾性队列研究

感染是老年患者类风湿关节炎 (RA) 治疗过程中的主要问题之一。然而，在老年患者中接受靶向治疗（TT）包括改善疾病的生物抗风湿药（bDMARDs）和 Janus 激酶抑制剂（JAKIs）的 RA 患者的感染风险很少。本研究的目的是比较年轻、老年和老年 RA 患者住院感染 (HI) 与 TT 与甲氨蝶呤 (MTX) 治疗的风险。使用日本索赔数据，符合以下标准的患者被纳入：（1）≥1 个 RA 的 ICD10 代码；(2) 2008 年 4 月至 2018 年 9 月期间，≥ 1 个 MTX 或 TT（bDMARDs 和 JAKIs）处方；（三）≥16岁。我们计算了每 100 患者年年轻人、老年人、和老年组（分别为 16-64、65-74 和 ≥75 岁）和 HI 的 IR 比率（TT 与 MTX）。使用逻辑回归模型来估计每组中 HI 和 TT 与 MTX 之间的关联。在年轻、年长和年长的老年人组中，每 100 患者年 HI 的总体 IR（95% 置信区间）分别为 3.2 [2.9-3.5]、5.0 [4.6-5.4] 和 10.1 [9.5-10.9] . 在老年人和老年组中，同时使用 MTX 或免疫抑制性 DMARD 与 TT 的频率较低。在年轻人和老年人中，TT 与 MTX 对 HI 的调整优势比为 1.3（1.0-1.7；p = 0.021）、0.79（0.61-1.0；p = 0.084）和 0.73（0.56-0.94；p = 0.015） , 和老年组。HI的整体IR随着年龄的增长而增加。