Risk: Benefit profile of etanercept in elderly patients with rheumatoid arthritis, ankylosing spondylitis or psoriatic arthritis

Rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) are commonly thought of as inflammatory diseases that affect younger individuals. Although the initial presentation of these diseases is commonly in a patient's twenties or thirties, they usually persist for the duration of the patient's life. In addition, up to one-third of patients with RA have disease onset after 60 years of age. Older patients with any of these three diseases are more likely to have more severe disease with significant functional decline. They are also more likely to have co-morbid diseases and use concomitant medications than patients who are younger. In patients with RA, AS or PsA, the introduction of anti-tumour necrosis factor (TNF)-alpha therapies such as etanercept, infliximab and adalimumab has had a significant impact in ameliorating the signs and symptoms of disease, improving patient function and inhibiting radiographic progression. Anti-TNF alpha therapies now have well recognised safety profiles that have been demonstrated in the usual clinical trial populations for these diseases, but such populations under-represent patients >= 65 years of age. This review explores the information currently available regarding patients aged >= 65 years treated with anti-TNF alpha therapies for RA, AS or PsA, focusing on etanercept in RA because of a lack of data for other therapies and conditions. The analyses conducted show that there is similar efficacy in the treatment of RA in patients < 65 years old and those >= 65 years of age. Although there are some differences in the adverse events noted in these two age groups, it appears as though treatment of patients >= 65 years of age, compared with age-matched controls, is not dissimilar to treatment of patients < 65 years of age compared with their age-matched controls. Only by understanding the risks and benefits of therapy in the older age group can a true risk : benefit profile for etanercept, and ultimately other anti-TNF alpha therapies, be determined by the practising physician and the patient.