Rheumatoid arthritis is a chronic autoimmune condition that causes inflammation in the joints, leading to pain and deformity. Its prevalence in Korea is estimated to be approximately 0.5–1%

Recently, with the development of new treatments and improved awareness of the disease, early diagnosis rates are on the rise.

In fact, over the past 5 years, the number of rheumatoid arthritis patients diagnosed in Korea has increased by more than 30%, with the elderly aged 50 and older accounting for 79% of all patients, highlighting the aging population.

As a result, it has become important to go beyond simple treatment and focus on addressing elderly patients. Professor Sang-heon Lee of the Rheumatology Department at Konkuk University Hospital, an expert with the latest insights in the field, emphasized the importance of selecting the right treatment and management for the growing number of elderly patients with rheumatoid arthritis.

According to Professor Lee, rheumatoid arthritis was once considered incurable, but with the advent of new treatments, perceptions have changed, increasing early diagnosis and treatment of the disease in general.

Professor Lee said, “With the message that rheumatoid arthritis is a treatable disease spreading, early diagnosis rates are also increasing. In the past, we only checked the condition of the patient's joints with the naked eye, but the development of imaging diagnostic technologies such as joint ultrasound and MRI, rendered early diagnosis possible.”

Another change is that, along with the overall aging population, the proportion of elderly patients with rheumatoid arthritis is also increasing. Professor Lee explained that elderly patients require a multifaceted approach to treatment, including management of complications, compared to younger patients.

He emphasized, “Just as machines lose functionality over time, elderly patients often have multiple comorbidities due to the decline of various bodily functions. Complications such as cardiovascular disease, cerebrovascular disease, and diabetes are common, and immune function is also impaired, so caution is necessary when using immunotherapy agents.”

10 Years since the launch of Simponi IV Formulation, GO-FURTHER study results gain attention

The emergence of TNF (tumor necrosis factor)-α inhibitors is an indispensable part of the paradigm shift in the treatment of rheumatoid arthritis.

These drugs have been used in clinical practice for more than 25 years and are still considered effective in treating approximately 70% of all patients.

Professor Lee stated, “The various treatment options developed since then have established themselves as alternatives for patients not adequately treated with TNF-α inhibitors. As such, TNF inhibitors remain the cornerstone of rheumatoid arthritis treatment. Even after patent expiry, biosimilars for TNF-α inhibitors are being launched most actively.”

Among such TNF-α inhibitors, Simponi (golimumab) was introduced in Korea in 2012 as a subcutaneous (SC) injection formulation, and in May 2015, an intravenous (IV) injection formulation was launched, offering faster symptom improvement, longer dosing intervals, and easier monitoring by healthcare professionals, and establisehd a strong market presence.

Professor Lee explained, “Simponi IV is a TNF-α inhibitor developed as a fully human monoclonal antibody, offering superior antibody purity and significantly reduced injection-related adverse reactions. While infliximab requires approximately two hours for administration, Simponi can be administered in about 30 minutes, and the dosing interval is every two months, significantly reducing the number of clinic visits.”

Professor Lee is particularly interested in the advantages of Simponi for the increasing number of elderly patients with rheumatoid arthritis.

A subanalysis of the GO-FURTHER study showed that Simponi IV showed more improvement in elderly patients aged 65 years or older.

Specifically, in a subanalysis of the GO-FURTHER study that divided patients with active rheumatoid arthritis into two groups—those under 65 years of age and those 65 years of age and older—Simponi demonstrated higher initial symptom improvement compared to the placebo group in the elderly patient group during the first 6 months.

At week 14, 61.0% of patients achieved ACR20, which was approximately six times higher than the placebo group (11.1%), and at Week 24, 69.5% of patients achieved ACR20, demonstrating significant clinical value of Simponi compared to the placebo group (33.3%).

Professor Lee said, “Although the overall numerical differences were not significant in younger patients, there were more meaningful differences in response speed and response rates in high-risk patients. Elderly patients often have reduced physical function due to inflammation, so when they respond to treatment, the improvement is much greater. In this regard, Simponi has clinical advantages for elderly patients.”

In terms of safety, Simponi IV did not show any new concerns in elderly patients.

He said, “Generally, super-elderly patients over the age of 70 are at high risk of infection, so careful monitoring is necessary regardless of the drug used. The safety data for Simponi in elderly patients is generally consistent with previous reports, and injection-related side effects were rare and mostly mild.”

“More treatment options emerge for rheumatoid arthritis... TNF-α inhibitors remain the cornerstone”

From a broad perspective, the development of new drugs with various mechanisms of action for the treatment of rheumatoid arthritis has led to a wider range of options.

In this regard, Professor Lee predicted that TNF-α inhibitors will remain competitive due to their accumulated treatment experience and safety data.

Professor Lee stated, “At present, TNF-α inhibitors will continue to maintain their position as the cornerstone of rheumatoid arthritis treatment because of their over 25 years of accumulated clinical experience and identification of most major side effects, which allow physicians to prescribe them with confidence.”

While new oral treatments like JAK inhibitors have emerged, concerns about long-term safety mean that TNF-α inhibitors remain the most trusted treatment option at this point.

“JAK inhibitors are highly effective, but as they regulate intracellular signaling, there are concerns about long-term safety, such as cancer development. At least 5 to 10 years of additional data will be required to verify this.”

In addition, Professor Lee emphasized the importance of personalized treatment for rheumatoid arthritis.

He explained, “While most patients are initially prescribed TNF-α inhibitors as first-line therapy, they may not be suitable for all patients. In cases where there are contraindications for TNF-α inhibitors, such as a history of tuberculosis or heart failure, alternative medications with different mechanisms of action are considered.”

Ultimately, the strategy of selecting the optimal medication based on the patient's individual condition and risk factors, and switching medications when necessary, is crucial.

Finally, the professor noted, “While anyone can prescribe medications, managing complications or the progression of comorbidities associated with aging, as well as appropriately addressing side effects, requires the experience and knowledge of specialized medical professionals. Early treatment that strongly suppresses inflammation in the initial stages can prevent disease recurrence and enable long-term management. Therefore, it is crucial to extinguish the inflammatory ‘sparks’ in the early stages through prompt treatment.”