Safety and effectiveness of treatment for rheumatoid arthritis in the elderly: what do registry and routine data tell us?

Elderly people are often excluded from randomised clinical trials due to chronic diseases, required drug therapies, or merely due to their age. When new drugs are approved, we therefore have little knowledge of their safety and efficacy in old age. This gap can be closed by observational real-world data. Registries and observational studies show that older people with rheumatoid arthritis (RA) are treated more cautiously than younger people with a view to the fact that they often already receive extensive pharmacotherapy. This can lead to a less successful control of RA disease activity and avoidable risks, e. g. from glucocorticoids. With regard to the effectiveness of targeted therapies, observational studies have revealed no relevant differences between younger and older patients. Drug survival of b/tsDMARD therapy is also comparable between older and younger patients. When assessing treatment safety, it should be borne in mind that older patients are more likely to experience adverse events that can be only partially attributed to the therapies. Thanks to large observational registries, groups of older people can be compared under different exposures. This article provides an overview of the frequency of serious events in patients of older age, in particular the risks of infections, malignancies, gastrointestinal perforations, and cardiovascular events.