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Vol. 7. Issue 2.
Pages 104-112 (March - April 2011)
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Vol. 7. Issue 2.
Pages 104-112 (March - April 2011)
Original article
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Systematic review: Safety and efficacy of anti-TNF in elderly patients
Revisión sistemática: eficacia y seguridad del tratamiento anti-TNF en pacientes ancianos
Noemi Busquetsa,
Corresponding author

Corresponding author.
, Loreto Carmonab, Xavier Surísa
a Servicio de Reumatología, Hospital de Granollers, Granollers, Barcelona, Spain
b Unidad de Investigación, Fundación Española de Reumatología, Madrid, Spain
Article information

To evaluate whether the safety and efficacy of anti-TNF treatments in elderly patients with rheumatic diseases is similar than the safety and efficacy of the same drugs in younger patients.


Systematic review. We performed a systematic search in MEDLINE (Pubmed), EMBASE (Ovid), and the Cochrane Library Plus. Abstracts published in the American and European rheumatology congresses and articles in Reumatología Clínica were also reviewed.


Ten studies fulfilled the inclusion criteria. Studies show a similar efficacy in elderly and younger patients. The differences between the young and the elderly regarding DAS28 reductions before and after are very small: 0.04 in the Geneway et al study and 0.0 in the Mariette et al study, as well as in the before and after HAQ: 0.04 (Geneway et al), 0.18 (Schiff et al) and 0.06 (Mariette et al).Adverse events reported in elderly and younger patients are 83.3% and 77.1% respectively with etanercept, as reported by Fleischmann; 27.2% vs 12.5%, P=.19, as reported by Chevillotte, and the rate of withdrawal due to an adverse event was 57,8% vs 29,2% with infliximab, P=.03, 36% vs 15% P=.06 with adalimumab and 10,3% and 9,5%, with no significant P value, as reported by Massara.


The information to assess the efficacy and safety of anti-TNF therapy in elderly patients was obtained in all cases from sub analyses and therefore bias is possible. We can say, with a low to moderate level of evidence, that elderly patients undergoing anti-TNF treatments have a higher number of adverse events, and similar efficacy, when compared with younger patients.

Biological therapy

Evaluar si la seguridad y la eficacia de los tratamientos anti TNF en pacientes ancianos con enfermedades reumáticas inflamatorias son similares a la seguridad y eficacia en pacientes jóvenes.


Revisión sistemática. Se realizó una búsqueda bibliográfica en Medline (vía Pubmed), Embase (vía Ovid) y Cochrane Library Plus, abstracts publicados en los congresos americano y europeo de reumatología y artículos publicados en Reumatología Clínica.


Diez estudios cumplían los criterios de inclusión. Los estudios coinciden en una eficacia similar en jóvenes y ancianos. Las diferencias en la reducción del DAS28 de antes y después entre jóvenes y ancianos son muy pequeñas: 0,04 en el estudio de Geneway et al y 0,0 en el de Mariette et al; así como en el HAQ de antes y después: 0,04 (Geneway et al), 0,18 (Schiff et al) y 0,06 (Mariette et al).

Los efectos adversos descritos en ancianos y jóvenes respectivamente son de 83,3% y 77,1% con etanercept, según Fleischmann; 27,2% vs. 12,5%, p=0,19, según Chevillotte; y 57,8% vs. 29,2% con infliximab, p=0,03, 36% vs. 15%, p=0,01 con adalimumab y de 10,3% vs. 9,5% con etanercept, p no significativa, según Massara.


La información para evaluar la eficacia y seguridad de los anti TNF en ancianos procede de subanálisis y por tanto se encuentra sujeta a sesgos. Podemos decir, con un nivel de evidencia bajo o moderado, que los ancianos presentan más acontecimientos adversos y similar eficacia que en los no ancianos cuando se tratan con agentes anti TNF.

Palabras clave:
Anti TNF
Terapia biológica
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Copyright © 2011. Sociedad Española de Reumatología and Colegio Mexicano de Reumatología
Reumatología Clínica (English Edition)

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