Re-escalation of Treatment in Older Adults with Rheumatoid Arthritis After Anti-TNF Therapy De-escalation

Sep 29, 2026

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Older adults with rheumatoid arthritis (RA) receiving biologic disease-modifying antirheumatic drugs (bDMARDs), including anti-TNFs, face elevated risks of serious infections and other adverse effects. Guidelines encourage de-escalation for patients with low disease activity or remission to improve the benefit–harm balance. Using 20% Medicare data from 2009–2017, investigators quantified how frequently and why patients re-escalate therapy after anti-TNF de-escalation, reporting 61.1% re-escalation and identifying demographic and comorbidity-related factors.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Abstract

Study design and population

Definitions and data collection

Outcomes and risk factors

Innovation in Aging, 2025, Vol. 9, No. S2 709 Abstract citation ID: igaf122.2417 RE-ESCALATION OF TREATMENT IN OLDER ADULTS WITH RHEUMATOID ARTHRITIS AFTER ANTI-TNF THERAPY DE-ESCALATION Jiha Lee1, Jonathan Martindale1, Una Makris2, and Julie Bynum1, 1. University of Michigan, Ann Arbor, Michigan, United States, 2. UT Southwestern Medical Center, Dallas, Texas, United States Older adults with rheumatoid arthritis (RA) treated with biologic disease-modifying antirheumatic drugs (bDMARDs), including anti-TNFs, are at an increased risk of serious infections and other adverse effects. Guidelines recommend de-escalating DMARDs for patients with low disease activity or remission to optimize the benefit-harm ratio of treatment. In a prior study, we observed that 20% of older adults with RA de-escalated anti-TNFs. This follow-up study examines the prevalence and factors associated with the re-escalation of treatment after anti-TNF de-escalation. We used 20% Medicare data from 2009-2017 to identify RA patients ≥66 years of age on anti-TNF therapy (Adalimumab, Etanercept, Certolizumab, or Golimumab), with de-escalation by cessation (> 90-day gap) or 710 Innovation in Aging, 2025, Vol. 9, No. S2 by taper (>50% effective dose reduction), and at least one rheumatologist visit pre- 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 the index date. Information on baseline patient characteristics, concomitant use of conventional synthetic DMARDs (csDMARDs), and changes in average glucocorticoids (GC) dose were collected. We identified 814 eligible Medicare beneficiaries, with an average age of 75.2 (SD 5.8), 84.5% female, 75.8% non-Hispanic white, and 43.4% with low-income subsidies (LIS). Of them, 61. 1% re-escalated treatment with a median time of 160 (IQR 112-290) days since the index-date. In Cox analyses, re-escalation was more likely among blacks, Hispanics/others, and those with lower comorbidity burdens. Overall, more than half of older RA patients re-escalate treatment within a year of anti-TNF de-escalation highlights the importance of bDMARDs for disease control.

FAQs

How was re-escalation defined after anti-TNF de-escalation?

Re-escalation meant restarting the same anti-TNF or another bDMARD, or increasing the effective dose by more than 50% after the index date.

What data source and time period were used in the study?

The study used 20% Medicare data from 2009 to 2017 to identify RA patients aged 66 years or older on anti-TNF therapy.

What proportion of older RA patients re-escalated within a year, and what factors increased likelihood?

Overall, 61.1% re-escalated, with a median time of 160 days; more frequent re-escalation was seen among Black patients, Hispanic/others, and those with lower comorbidity burdens.

Sep 29, 2026

Upload by Damian