TY - JOUR T1 - Safety and efficacy of baricitinib in elderly patients with rheumatoid arthritis JF - RMD Open JO - RMD Open DO - 10.1136/rmdopen-2017-000546 VL - 3 IS - 2 SP - e000546 AU - Roy Fleischmann AU - Jahangir Alam AU - Vipin Arora AU - John Bradley AU - Douglas E Schlichting AU - David Muram AU - Josef S Smolen Y1 - 2017/10/01 UR - http://rmdopen.bmj.com/content/3/2/e000546.abstract N2 - Key messagesWhat is already known about this subject?Elderly patients with rheumatoid arthritis (RA) often have comorbid diseases managed with multiple concomitant medications with the potential for changes in drug pharmacokinetics and pharmacodynamics, which complicate therapeutic decisions.There may be an increased risk in elderly patients for institution of biologic disease-modifying antirheumatic drugs in the treatment of RA.What does this study add?We have demonstrated similar efficacy of baricitinib in elderly and younger patients and incidence of serious adverse events (AE) or withdrawal due to AEs in baricitinib-treated patients that were similar to age-matched placebo-treated patients.How might this impact on clinical practice?Age is not a contraindication to the institution of targeted therapies, including baricitinib; given their comorbidities and changed pharmacodynamics, elderly patients with RA should be followed carefully to be sure that there is a reasonable risk:benefit profile of baricitinib in individual patients.Rheumatoid arthritis (RA) can begin at any age, but the prevalence increases with age. Active disease usually persists for years; many patients have initial symptoms after age 60.1 2 Elderly patients with RA often have comorbid diseases managed with multiple concomitant medications with the potential for changes in drug pharmacokinetics and pharmacodynamics, which complicate therapeutic decisions.3 Moreover, there is a perception that medications may be less effective than in younger individuals and adverse effects more common and severe.4 5 One report suggests an increased risk in elderly patients for adverse events (AE) leading to discontinuation of biologic disease-modifying antirheumatic drugs (bDMARD) in the treatment of RA, while other reports have not seen these effects.4 5 An analysis of Medicare beneficiaries with RA suggested that older patients were less likely to receive conventional synthetic disease-modifying antirheumatic drugs (csDMARD) and therefore may not receive optimal treatment.6 Other reports have shown that responsiveness of elderly patients with RA to methotrexate (MTX) or tumour necrosis factor (TNF) inhibitors+MTX was similar to that observed in … ER -