Applicability of trials in rheumatoid arthritis and osteoarthritis

A systematic review and meta-analysis of trial populations showing adequate proportion of women, but underrepresentation of elderly people

Andriko Palmowski, Thomas Buttgereit, Yannick Palmowski, Sabrina M Nielsen, Maarten Boers, Robin Christensen, Frank Buttgereit

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Abstract

OBJECTIVES: To evaluate whether elderly people and women are adequately represented in randomized controlled trials (RCT) in rheumatoid arthritis (RA) and osteoarthritis (OA).

METHODS: Four systematic searches in MEDLINE yielded RCT in RA and OA on any intervention published in 2016 and 2017 and population-based studies (PBS) in RA and OA published between 2013 and 2017. Random effects meta-analyses estimated the pooled proportion of elderly people (defined as being ≥ 65 years old), the mean age, its standard deviation (SD), and the proportion of women stratified by disease (RA and OA) and study type (RCT and PBS). Stratified estimates were subsequently compared.

RESULTS: 265 RCT comprising 51,240 participants and 53 PBS comprising 523,630 participants were included. In both RA and OA, RCT included lower proportions of elderly people than PBS: RA -0.18 (95% confidence interval -0.22 to -0.13); OA -0.20 (-0.30 to -0.09); had lower mean ages: RA -5.2 years (-6.8 to -3.5); OA -4.7 years (-7.5 to -2.0); and smaller SD: RA -1.9 years (-2.6 to -1.3); OA -2.7 years (-4.2 to -1.2); (all comparisons: p ≤ 0.001). Proportions of women were comparable in RCT compared to PBS in both RA and OA.

CONCLUSIONS: While women are adequately represented in RA and OA trials, the elderly are underrepresented, probably limiting applicability of current evidence to this growing subgroup. It is urgent to improve the inclusion of elderly people in clinical trials and study age as a determinant for outcome.

Original languageEnglish
JournalSeminars in Arthritis and Rheumatism
Volume48
Issue number6
Pages (from-to)983-989
ISSN0049-0172
DOIs
Publication statusPublished - Jun 2019

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Meta-Analysis
Randomized Controlled Trials
Population
MEDLINE
Clinical Trials
Confidence Intervals

Keywords

  • Applicability
  • Elderly
  • Generalizability
  • Osteoarthritis
  • Rheumatoid arthritis
  • Women

Cite this

@article{8d487f4406be4711ad35fd2f0e970ffd,
title = "Applicability of trials in rheumatoid arthritis and osteoarthritis: A systematic review and meta-analysis of trial populations showing adequate proportion of women, but underrepresentation of elderly people",
abstract = "OBJECTIVES: To evaluate whether elderly people and women are adequately represented in randomized controlled trials (RCT) in rheumatoid arthritis (RA) and osteoarthritis (OA).METHODS: Four systematic searches in MEDLINE yielded RCT in RA and OA on any intervention published in 2016 and 2017 and population-based studies (PBS) in RA and OA published between 2013 and 2017. Random effects meta-analyses estimated the pooled proportion of elderly people (defined as being ≥ 65 years old), the mean age, its standard deviation (SD), and the proportion of women stratified by disease (RA and OA) and study type (RCT and PBS). Stratified estimates were subsequently compared.RESULTS: 265 RCT comprising 51,240 participants and 53 PBS comprising 523,630 participants were included. In both RA and OA, RCT included lower proportions of elderly people than PBS: RA -0.18 (95{\%} confidence interval -0.22 to -0.13); OA -0.20 (-0.30 to -0.09); had lower mean ages: RA -5.2 years (-6.8 to -3.5); OA -4.7 years (-7.5 to -2.0); and smaller SD: RA -1.9 years (-2.6 to -1.3); OA -2.7 years (-4.2 to -1.2); (all comparisons: p ≤ 0.001). Proportions of women were comparable in RCT compared to PBS in both RA and OA.CONCLUSIONS: While women are adequately represented in RA and OA trials, the elderly are underrepresented, probably limiting applicability of current evidence to this growing subgroup. It is urgent to improve the inclusion of elderly people in clinical trials and study age as a determinant for outcome.",
keywords = "Applicability, Elderly, Generalizability, Osteoarthritis, Rheumatoid arthritis, Women",
author = "Andriko Palmowski and Thomas Buttgereit and Yannick Palmowski and Nielsen, {Sabrina M} and Maarten Boers and Robin Christensen and Frank Buttgereit",
note = "Copyright {\circledC} 2018. Published by Elsevier Inc.",
year = "2019",
month = "6",
doi = "10.1016/j.semarthrit.2018.10.017",
language = "English",
volume = "48",
pages = "983--989",
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Applicability of trials in rheumatoid arthritis and osteoarthritis : A systematic review and meta-analysis of trial populations showing adequate proportion of women, but underrepresentation of elderly people. / Palmowski, Andriko; Buttgereit, Thomas; Palmowski, Yannick; Nielsen, Sabrina M; Boers, Maarten; Christensen, Robin; Buttgereit, Frank.

In: Seminars in Arthritis and Rheumatism, Vol. 48, No. 6, 06.2019, p. 983-989.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Applicability of trials in rheumatoid arthritis and osteoarthritis

T2 - A systematic review and meta-analysis of trial populations showing adequate proportion of women, but underrepresentation of elderly people

AU - Palmowski, Andriko

AU - Buttgereit, Thomas

AU - Palmowski, Yannick

AU - Nielsen, Sabrina M

AU - Boers, Maarten

AU - Christensen, Robin

AU - Buttgereit, Frank

N1 - Copyright © 2018. Published by Elsevier Inc.

PY - 2019/6

Y1 - 2019/6

N2 - OBJECTIVES: To evaluate whether elderly people and women are adequately represented in randomized controlled trials (RCT) in rheumatoid arthritis (RA) and osteoarthritis (OA).METHODS: Four systematic searches in MEDLINE yielded RCT in RA and OA on any intervention published in 2016 and 2017 and population-based studies (PBS) in RA and OA published between 2013 and 2017. Random effects meta-analyses estimated the pooled proportion of elderly people (defined as being ≥ 65 years old), the mean age, its standard deviation (SD), and the proportion of women stratified by disease (RA and OA) and study type (RCT and PBS). Stratified estimates were subsequently compared.RESULTS: 265 RCT comprising 51,240 participants and 53 PBS comprising 523,630 participants were included. In both RA and OA, RCT included lower proportions of elderly people than PBS: RA -0.18 (95% confidence interval -0.22 to -0.13); OA -0.20 (-0.30 to -0.09); had lower mean ages: RA -5.2 years (-6.8 to -3.5); OA -4.7 years (-7.5 to -2.0); and smaller SD: RA -1.9 years (-2.6 to -1.3); OA -2.7 years (-4.2 to -1.2); (all comparisons: p ≤ 0.001). Proportions of women were comparable in RCT compared to PBS in both RA and OA.CONCLUSIONS: While women are adequately represented in RA and OA trials, the elderly are underrepresented, probably limiting applicability of current evidence to this growing subgroup. It is urgent to improve the inclusion of elderly people in clinical trials and study age as a determinant for outcome.

AB - OBJECTIVES: To evaluate whether elderly people and women are adequately represented in randomized controlled trials (RCT) in rheumatoid arthritis (RA) and osteoarthritis (OA).METHODS: Four systematic searches in MEDLINE yielded RCT in RA and OA on any intervention published in 2016 and 2017 and population-based studies (PBS) in RA and OA published between 2013 and 2017. Random effects meta-analyses estimated the pooled proportion of elderly people (defined as being ≥ 65 years old), the mean age, its standard deviation (SD), and the proportion of women stratified by disease (RA and OA) and study type (RCT and PBS). Stratified estimates were subsequently compared.RESULTS: 265 RCT comprising 51,240 participants and 53 PBS comprising 523,630 participants were included. In both RA and OA, RCT included lower proportions of elderly people than PBS: RA -0.18 (95% confidence interval -0.22 to -0.13); OA -0.20 (-0.30 to -0.09); had lower mean ages: RA -5.2 years (-6.8 to -3.5); OA -4.7 years (-7.5 to -2.0); and smaller SD: RA -1.9 years (-2.6 to -1.3); OA -2.7 years (-4.2 to -1.2); (all comparisons: p ≤ 0.001). Proportions of women were comparable in RCT compared to PBS in both RA and OA.CONCLUSIONS: While women are adequately represented in RA and OA trials, the elderly are underrepresented, probably limiting applicability of current evidence to this growing subgroup. It is urgent to improve the inclusion of elderly people in clinical trials and study age as a determinant for outcome.

KW - Applicability

KW - Elderly

KW - Generalizability

KW - Osteoarthritis

KW - Rheumatoid arthritis

KW - Women

U2 - 10.1016/j.semarthrit.2018.10.017

DO - 10.1016/j.semarthrit.2018.10.017

M3 - Journal article

VL - 48

SP - 983

EP - 989

JO - Seminars in Arthritis and Rheumatism

JF - Seminars in Arthritis and Rheumatism

SN - 0049-0172

IS - 6

ER -