Systematic review for the treatment of older rheumatoid arthritis patients informing the 2020 update of the Japan College of Rheumatology clinical practice guidelines for the management of rheumatoid arthritis

Takahiko Sugihara, Yutaka Kawahito, Akio Morinobu, Yuko Kaneko, Yohei Seto, Toshihisa Kojima, Hiromu Ito, Masataka Kohno, Takeo Nakayama, Yasumori Sobue, Keiichiro Nishida, Isao Matsushita, Atsuko Murashima, Masaaki Mori, Eiichi Tanaka, Shintaro Hirata, Mitsumasa Kishimoto, Hisashi Yamanaka, Masayo Kojima, Masayoshi Harigai

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: To provide an evidence base for clinical practice guidelines (CPG) for the management of rheumatoid arthritis (RA) in older adults. Methods: PubMed, Cochrane library, and Japan Centra Revuo Medicina databases were searched for articles published between 1990 and 2019. Quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system, with some modifications. Results: Among 702 identified articles, there were 5 post-hoc analyses of randomized controlled trials and 10 observational studies. Meta-analysis of the former yielded a mean difference of the van der Heijde-modified total Sharp score of −2.79 (95% confidence interval [CI] − 3.74 to −1.84) for treatment with tumor necrosis factor inhibitors. The risk ratio (RR) for the American College of Rheumatology 50% response rate, and for serious adverse events was 2.83 (95%CI 1.90–4.21) and 1.32 (95%CI 0.53–3.31), respectively, for Janus kinase inhibitors. Meta-analysis of the observational studies yielded an RR for disease activity score-28 remission and serious infections of 0.76 (95%CI 0.64–0.91) and 1.92 (95%CI 1.31–2.81) for older-versus-younger patients receiving biological disease-modifying antirheumatic drugs, respectively. Conclusion: This systematic review provides the necessary evidence for developing CPG for the management of RA in older adults.

Original languageEnglish
JournalModern Rheumatology
DOIs
Publication statusAccepted/In press - 2021
Externally publishedYes

Keywords

  • GRADE system
  • JAK inhibitors
  • biological DMARDs
  • meta-analysis
  • older RA

ASJC Scopus subject areas

  • Rheumatology

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