Age and biologic agents in autoimmune diseases

Dr Bhaskar Dasgupta is a consultant in rheumatology, head of the Rheumatology Department at Southend University Hospital (UK), and leading expert behind guidelines on polymyalgia rheumatica and giant cell arteritis.

Is age a contraindication to the use of biologic drugs in patients with autoimmune diseases?

Bhaskar Dasgupta, MB BS, MD: Per se, I think, age is not a contraindication and certainly if a patient has active disease, inflammatory disease, you can use whichever biologic agent you want to use. The problem is if the patient at a certain age also has lots of comorbid conditions—if the patient has heart failure, a pulmonary problem, renal failure, diabetes, or some other condition that predisposes that patient to infection or to adverse events from the biologic agents. We have to be very careful. But per se, chronologic age does not actually constitute a contraindication to the use of a biologic agent.

In a fit, say, 80-year-old person who has active rheumatoid arthritis (RA) I would certainly have no problems in using a biologic agent to control their RA.