Dig Dis Sci. 2021 Jul 15. doi: 10.1007/s10620-021-07129-5. Online ahead of print.

Baldeep S Pabla ¹, C Alex Wiles ², James C Slaughter ³, Elizabeth A Scoville ⁴, Robin L Dalal ⁴, Dawn B Beaulieu ⁴, David A Schwartz ⁴, Sara N Horst ⁴

Author information

• ¹Division of Internal Medicine, Department of Gastroenterology, Vanderbilt Inflammatory Bowel Diseases Center, Vanderbilt University Medical Center, 719 Thompson Lane, Suite 20500, Nashville, TN, 37204, USA. baldeep.pabla@vumc.org.
• ²Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, USA.
• ³Department of Biostatistics, Vanderbilt University, Nashville, USA.
• ⁴Division of Internal Medicine, Department of Gastroenterology, Vanderbilt Inflammatory Bowel Diseases Center, Vanderbilt University Medical Center, 719 Thompson Lane, Suite 20500, Nashville, TN, 37204, USA.

Abstract

Background: Vedolizumab is a monoclonal antibody used to treat inflammatory bowel disease (IBD). There is little known about the safety and comparative efficacy of this agent in the elderly population.

Aims: Here, we present data on the safety and comparative efficacy of vedolizumab versus tumor necrosis factor α antagonists (anti-TNF) in elderly patients with IBD.

Methods: This retrospective cohort study included IBD patients started on vedolizumab or anti-TNF at age 60 or older at a single tertiary IBD center. Safety was evaluated by assessing for the development of serious infection. The comparative needs for IBD-related surgery, IBD-related hospitalization, and drug discontinuation for any reason were obtained. Efficacy was assessed by comparing changes in endoscopic, histologic, and patient-report outcomes.

Results: 212 cases were identified-108 patients treated with vedolizumab and 104 patients treated with anti-TNF. There were no significant differences between cohorts in serious infection, surgical intervention, or IBD-hospitalization-free survival (p = NS). Drug discontinuation survival was different between anti-TNF and vedolizumab (p = 0.02) with more patients remaining on vedolizumab at the time of last follow-up (51.9% vs. 25.9%). Endoscopic remission and response rates were higher in the vedolizumab versus anti-TNF group (65.7% vs. 45.2%, p = 0.02; 80.0% vs. 59.3%, p < 0.001).

Conclusions: In a cohort of IBD patients over age 60, vedolizumab showed no statistically significant differences in infection, hospitalization, or surgical intervention-free survival as compared to anti-TNF. Vedolizumab was discontinued less frequently than anti-TNF. Patients on vedolizumab had higher rates of endoscopic remission and response.