Document Detail


Leflunomide treatment in elderly patients with rheumatoid or psoriatic arthritis: retrospective analysis of safety and adherence to treatment.
MedLine Citation:
PMID:  19552491     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Disease-modifying antirheumatic drugs (DMARDs) play a crucial role in the treatment of persistent chronic synovitis, such as active rheumatoid arthritis (RA) and spondyloarthritis, by inducing or maintaining disease remission, reducing the frequency of flares or relapses, and allowing corticosteroids to be tapered while maintaining disease control. OBJECTIVE: The aim of this retrospective study was to evaluate the safety of, and adherence to treatment with, leflunomide in elderly RA and psoriatic arthritis patients compared with younger patients. METHODS: A total of 90 Italian patients (80 with active RA and 10 with psoriatic arthritis) were retrospectively examined at entry and after 24 months' follow-up. Patients were divided into two groups according to age: those aged <or=65 years (n = 50) and those aged >65 years (n = 40). Each patient was analysed for clinical, demographic and laboratory parameters in order to evaluate liver, renal and haematological toxicity. Disease Activity Score including a 28-joint count (DAS28) and physician global assessment of disease activity (MD global) were measured to define disease activity. RESULTS: During the 24-month follow-up period, 30 patients (33.3%) discontinued leflunomide: 17 patients (34.0%) in the group of patients aged <or=65 years and 13 patients (32.5%) in those aged >65 years. There were no differences in treatment withdrawal between the two groups. Overall, 10 patients (11.1%) in the entire study population discontinued leflunomide for lack of efficacy, while 21 (23.3%) discontinued the drug because of adverse effects (one patient withdrew because of both inefficacy and adverse effects). There were no significant differences in efficacy or adverse effects between patients aged <or=65 years and patients aged >65 years. There was also no significant difference in survival rates of leflunomide treatment when patients aged <or=65 years were compared with patients aged >65 years (p = 0.94). There were no significant differences in withdrawal rates in the overall population when leflunomide monotherapy was compared with leflunomide combination therapy. There were also no significant differences in the types of adverse effects associated with monotherapy or combination therapy when the two age groups were compared. CONCLUSIONS: Leflunomide is a useful and well tolerated DMARD for the treatment of RA and psoriatic arthritis in the elderly. The safety profile of, and adherence to, leflunomide is not different in older patients with chronic inflammatory joint diseases such as RA or psoriatic arthritis to that observed in younger patients.
Authors:
Stefano Alivernini; Daniela Mazzotta; Angelo Zoli; Gianfranco Ferraccioli
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Drugs & aging     Volume:  26     ISSN:  1170-229X     ISO Abbreviation:  Drugs Aging     Publication Date:  2009  
Date Detail:
Created Date:  2009-06-25     Completed Date:  2009-08-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9102074     Medline TA:  Drugs Aging     Country:  New Zealand    
Other Details:
Languages:  eng     Pagination:  395-402     Citation Subset:  IM    
Affiliation:
Division of Rheumatology UCSC-Catholic University of Rome, Rome, Italy.
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MeSH Terms
Descriptor/Qualifier:
Adult
Age Factors
Aged
Antirheumatic Agents / adverse effects,  therapeutic use*
Arthritis, Psoriatic / drug therapy*
Arthritis, Rheumatoid / drug therapy*
Female
Follow-Up Studies
Humans
Isoxazoles / adverse effects,  therapeutic use*
Italy / epidemiology
Male
Medication Adherence
Middle Aged
Retrospective Studies
Severity of Illness Index
Survival Rate
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antirheumatic Agents; 0/Isoxazoles; 75706-12-6/leflunomide

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