Background: Clinical management of elderly patients with rheumatoid arthritis (RA) is frequently complicated by concerns regarding polypharmacy and therapeutic safety, often leading to clinical inertia. While switching biologic disease-modifying antirheumatic drugs (bDMARDs) is a standard strategy for treatment failure in younger populations, the specific benefits regarding functional recovery in the elderly population remain to be fully elucidated.

Objectives: This study aimed to investigate whether a bDMARD switching strategy provides superior clinical and functional outcomes compared to a maintenance (“wait and see”) approach in elderly RA patients (≥65 years) using an overlap-weighting (OW) methodology to ensure a robust comparative analysis.

Methods: Utilizing the KOBIO prospective cohort, we analyzed 112 elderly patients (mean age 71.1 years) with moderate-to-high disease activity (CDAI > 10) following initial bDMARD failure. Overlap Weighting (OW) was employed to mitigate baseline selection bias between the switching (n=42) and maintenance (n=70) cohorts (Max SMD = 0.0376). Outcomes were primarily assessed based on 12-month changes in CDAI and RAPID3.

Results: The switching group demonstrated a statistically significant superior reduction in CDAI compared to the maintenance group (-10.51 vs. -5.38; p=0.038). Notably, although the 12-month change in RAPID3 did not reach formal statistical significance (p=0.352), the switching cohort exhibited a substantially greater numerical improvement (-3.27) relative to the maintenance cohort (-1.88). Furthermore, the switching strategy was associated with higher adjusted odds for achieving a Minimal Clinically Important Difference (MCID) (OR 1.78) and Low Disease Activity (LDA) (OR 1.68). These findings suggest that therapeutic intensification through switching confers a clinically meaningful advantage in both objective disease activity and patient-reported functional status, even when statistical power is limited.

Conclusions: In elderly patients with RA, a bDMARD switching strategy facilitates a more effective reduction in disease activity as well as a more favorable trajectory of functional recovery compared to treatment maintenance. These data suggest that advanced age should not preclude the consideration of switching strategies, and a proactive switching approach may be essential to optimize long-term functional independence and quality of life in this vulnerable demographic.

REFERENCES: NIL.

Acknowledgments: NIL.

Disclosure of Interests: None declared.