• 作者：Noemi Busquets^a ; ^{noemibp76@hotmail.com} ; Loreto Carmona^b ; Xavier Sur&#237 ; s^a
• 关键词：Anti TNF ; Ancianos ; Seguridad ; Eficacia ; Terapia bioló ; gica
• 刊名：Reumatolog铆a Cl铆nica
• 出版年：2011
• 期刊代码：pca303_1699258X
• 类别：med
• 出版时间：March-April 2011
• 卷：7
• 期：2
• 页码：104-112
• 文件大小：695 K

Objective

To evaluate whether the safety and efficacy of anti-TNF treatments in elderly patients with rheumatic diseases is similar than the safety and efficacy of the same drugs in younger patients.

Methods

Systematic review. We performed a systematic search in MEDLINE (Pubmed), EMBASE (Ovid), and the Cochrane Library Plus. Abstracts published in the American and European rheumatology congresses and articles in Reumatolog铆a Cl铆nica were also reviewed.

Results

Ten studies fulfilled the inclusion criteria. Studies show a similar efficacy in elderly and younger patients. The differences between the young and the elderly regarding DAS28 reductions before and after are very small: 0.04 in the Geneway et al study and 0.0 in the Mariette et al study, as well as in the before and after HAQ: 0.04 (Geneway et al), 0.18 (Schiff et al) and 0.06 (Mariette et al).Adverse events reported in elderly and younger patients are 83.3%and 77.1%respectively with etanercept, as reported by Fleischmann; 27.2%vs 12.5%, p=0.19, as reported by Chevillotte, and the rate of withdrawal due to an adverse event was 57,8%vs 29,2%with infliximab, p=0.03, 36%vs 15%p=0.06 with adalimumab and 10,3%and 9,5%, with no significant p value, as reported by Massara.

Conclusions

The information to assess the efficacy and safety of anti-TNF therapy in elderly patients was obtained in all cases from sub analyses and therefore bias is possible. We can say, with a low to moderate level of evidence, that elderly patients undergoing anti-TNF treatments have a higher number of adverse events, and similar efficacy, when compared with younger patients.