Leflunomide Treatment in Elderly Patients with Rheumatoid or Psoriatic Arthritis: Restrospective Analysis of Safety and Adherence to Treatment

22 Sep, 10

Leflunomide Treatment in Elderly Patients with Rheumatoid or Psoriatic Arthritis: Retrospective Analysis of Safety and Adherence to Treatment

Objective

To evaluate the safety of, and adherence to treatment with, leflunomide (LEF) 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 -
- Aged ≤65 years- n = 50
- Aged >65 years- n = 40
Each patient was analysed for clinical, demographic and laboratory parameters in order to evaluate liver, renal and haematological toxicity.
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 LEF:
- 17 patients (34.0%) in the group of patients aged ≤65 years and
- 13 patients (32.5%) in those aged >65 years.
There were no differences in treatment withdrawal between the two groups.
Overall, in the entire study population:
- Discontinuation due to lack of efficacy -10 patients (11.1%)
- Discontinuation because of adverse effects - 21 (23.3%) (1 patient withdrew because of both inefficacy and adverse effects).
There were no significant differences in -
- Efficacy or adverse effects between patients aged ≤65 years and patients aged >65 years.
- Survival rates of LEF treatment when patients aged ≤65 years were compared with patients aged >65 years (p = 0.94).
- Withdrawal rates in the overall population when LEF monotherapy was compared with LEF combination therapy.
- Types of adverse effects associated with monotherapy or combination therapy when the two age groups were compared.

Conclusions

LEF is a useful and well tolerated DMARD for the treatment of RA and psoriatic arthritis in the elderly.
Safety profile of, and adherence to, LEF is not different in older patients with chronic inflammatory joint diseases to that observed in younger patients.

Drugs Aging. 2009; 26(5): 395-402.