Comparative safety and effectiveness of tumor necrosis factor α antagonists and vedolizumab in elderly IBD patients: a multicentre study.

Abstract

BACKGROUND:

The older patient group with inflammatory bowel diseases (IBD) is particularly vulnerable to consequences of disease and therapy-related side effects but little is known about the best treatment options in this population.

AIM:

To compare safety and efficacy of tumor necrosis factor α antagonist (anti-TNF) or vedolizumab (VDZ) in patients with IBD >60 years of age.

METHODS:

This retrospective study included patients with Crohn's disease (CD) or ulcerative colitis (UC) initiating anti-TNF or VDZ therapy ≥60 years of age at three study sites. We examined occurrence of infection or malignancy within 1 year after therapy as our primary outcome. Our efficacy outcomes included clinical remission at 3, 6 and 12 months. Multivariable logistic regression models adjusting for relevant confounders estimated odds ratios (OR) and 95% confidence intervals.

RESULTS:

The study included 131 anti-TNF and 103 VDZ initiated patients (age range 60-88 years). Approximately half had CD. At 1 year, there were no significant differences in safety profile between the two therapeutic classes. Infections were observed in 20% of anti-TNF-treated and 17% of VDZ-treated patients (P = 0.54). Pneumonia was the most common infection in both groups. While more anti-TNF-treated CD patients were in remission at 3 months compared to VDZ (OR 2.82, 95% CI 1.18-6.76), this difference was not maintained at 6 and 12 months suggesting similar efficacy of both classes.

CONCLUSIONS:

Both anti-TNF and VDZ therapy were similarly effective and safe in elderly IBD patients.

• Authors: Tomer Adar, David Faleck, Saranya Sasidharan, Kelly Cushing, Nienke Z Borren, Niharika Nalagatla, Ryan Ungaro, Wayne Sy, Samuel C Owen, Anish Patel, Benjamin L Cohen, Ashwin N Ananthakrishnan
• Journal: Alimentary pharmacology & therapeutics (Aliment Pharmacol Ther) Vol. 49 Issue 7 Pg. 873-879 (04 2019) ISSN: 1365-2036 [Electronic] England
• PMID: 30773667 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © 2019 John Wiley & Sons Ltd.

Chemical References

• Antibodies, Monoclonal, Humanized
• Gastrointestinal Agents
• Tumor Necrosis Factor Inhibitors
• vedolizumab

Topics

• Aged
• Aged, 80 and over
• Antibodies, Monoclonal, Humanized (therapeutic use)
• Cohort Studies
• Female
• Gastrointestinal Agents (therapeutic use)
• Humans
• Inflammatory Bowel Diseases (diagnosis, drug therapy)
• Male
• Middle Aged
• Retrospective Studies
• Treatment Outcome
• Tumor Necrosis Factor Inhibitors (therapeutic use)