ArticleBMC rheumatology2026
Real-world treatment courses after anti-TNF de-escalation in older adults with rheumatoid arthritis: a medicare cohort study.
Article in BMC rheumatology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
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Abstract
objectiveOlder adults with rheumatoid arthritis (RA) treated with biologic disease-modifying antirheumatic drugs (bDMARDs), including anti-TNFs, are at an increased risk of adverse effects. Current guidelines recommend de-escalating DMARDs for patients with low disease activity or remission to optimize the benefit-harm ratio of treatment. Our prior study found that two-thirds of older adults with RA de-escalated anti-TNFs yet real-world treatment courses after de-escalation in older adults are poorly understood. We aimed to describe real-world post-de-escalation treatment courses and identify factors associated with re-escalation.
methodsWe used 20% Medicare data from 2009 to 2022 to identify RA patients ≥ 66 years of age on anti-TNF therapy with de-escalation by cessation (> 90-day gap) or by taper (> 50% effective dose reduction), and at least one rheumatologist visits pre- and post-de-escalation (i.e., index date). Re-escalation was defined as restarting the same anti-TNF or another bDMARD or increasing the effective dose by > 50% after de-escalation. Those without re-escalation were considered to have sustained de-escalation. Multivariable Cox proportional hazards regression models were used to identify factors associated with re-escalation, relative to sustained de-escalation.
resultsAmong 949 beneficiaries who met inclusion criteria, the mean age was 75.1 years, 82.5% were female, and 41.9% had low-income subsidies (LIS). 38.4% sustained de-escalation, while 61.6% re-escalated treatment with a median time to re-escalation of 164 (IQR 113–301) days. In Cox analyses, re-escalation, compared to sustained de-escalation, was more likely among individuals who were Black, Hispanic/other, and with a lower comorbidity burden.
conclusionsNearly four in ten older adults with RA sustained de-escalation of anti-TNF, supporting the feasibility for selected individuals in routine practice. Most re-escalations occurred within six months, suggesting a need for closer follow-up early after de-escalation. CLINICAL TRIAL NUMBER: Not applicable.
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