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. 2025 Aug 12.
doi: 10.1007/s10067-025-07615-5. Online ahead of print.

Age-related disparities in biologic therapy initiation among rheumatoid arthritis patients: Insights from a large retrospective cohort study

Sanjot Sunner  1 , Britney Jones  1 , C Allyson Jones  1 , Yazid N Al Hamarneh  1 , Cheryl Sadowski  1 , Walter P Maksymowych  1 , Elaine A Yacyshyn  2
Affiliations

Age-related disparities in biologic therapy initiation among rheumatoid arthritis patients: Insights from a large retrospective cohort study

Sanjot Sunner et al. Clin Rheumatol. .

Abstract

Objective: Rheumatoid arthritis (RA) is a chronic inflammatory condition with increasing prevalence, particularly in older adults. This study examined differences in prescribing patterns of biologic DMARDs (bDMARDs) between younger (< 65 years) and older (≥ 65 years) adults and explored factors influencing delays in therapy initiation.

Methods: A retrospective comparison of bDMARD use in younger (< 65 years) and older (≥ 65 years) adults who have RA was conducted using data from the Rheumatoid Arthritis Pharmacovigilance Program and Outcomes Research in Therapeutics (RAPPORT) registry. Disease activity was assessed using the Disease Activity Score (DAS28) and Health Assessment Questionnaire (HAQ). multivariable regression analysis was performed to explore factors associated with delayed bDMARD prescription.

Results: Among 3411 patients, older adults experienced significantly longer delays in bDMARD initiation compared to younger patients (p < 0.0001). Older adults also demonstrated higher disease activity (HAQ: 1.75 vs. 1.48, DAS28: 5.95 vs. 5.49, both p < 0.0001) and elevated inflammatory markers. Regression analysis revealed that advanced age, comorbidity burden, smoking, and seropositivity were associated with delays in bDMARD initiation.

Conclusion: Despite evidence supporting bDMARD efficacy and safety, older RA patients face significant delays in therapy, leading to suboptimal disease control and increased adverse outcomes. Addressing age-related barriers to RA treatment is critical to improving equitable access. Further research is needed to investigate mechanisms underlying these disparities and assess the benefits of timely bDMARD initiation on long-term outcomes in older adults. Key Points • Older adults with rheumatoid arthritis experience significant delays in biologic therapy initiation compared to younger patients. • Addressing age-related treatment disparities is crucial for improving disease outcomes and quality of life. • Future research should investigate clinician hesitancy and patient barriers to timely biologic therapy initiation.

Keywords: Biologic therapy; Disease modifying antirheumatic drugs; Older adults; Rheumatoid arthritis; Treatment disparities.

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Conflict of interest statement

Declarations. Ethics approval: 00001822. Conflict of interest: None.

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