Immunomodulators in managing geriatric rheumatoid arthritis
Keywords:
Immunosenescence, geriatric rheumatoid arthritis, pharmacokinetic parameters, rheumatoid arthritis, RAAbstract
Immunosenescence, the aging of immune system, is known to be a risk factor for infection and cancer. Advanced age has been associated with a wide range of disorders linked to both innate and adaptive immune systems. Further, the associated comorbidities like diabetes, renal failure, malignancy etc., lead to an immunosuppressed state, which needs greater precautions. Age also modifies drug-related pharmacokinetic parameters like absorption, distribution, metabolism, and excretion. All these factors warrant cautious use of immunomodulators in elderly rheumatoid arthritis (RA) patients. Moreover, majority of the clinical trials exclude the elderly population and limit their studies only to younger subjects. This selection bias, along with limited studies on geriatric population, makes the management of this special group of patients very challenging. Even though, the present evidence from clinical trials suggests that DMARDs and biologic agents have good efficacy and safety profile in elderly patients with RA, such individuals are often undertreated. The present data is not sufficient for the development of evidence-based guidelines for this population. Thus, additional clinical studies focusing on pharmacokinetics, efficacy, and safety of immunomodulators in elderly patients are warranted.
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