Curr Gastroenterol Rep. 2023 Jul;25(7):160-168. doi: 10.1007/s11894-023-00874-9.Epub 2023 May 25.

Benjamin Clement ¹, Kara De Felice ², Anita Afzali ¹

Author information

¹Department of Digestive Diseases, University of Cincinnati, 231 Albert Sabin Way, ML 0547, Cincinnati, OH, 45267, USA.

²Department of Digestive Diseases, University of Cincinnati, 231 Albert Sabin Way, ML 0547, Cincinnati, OH, 45267, USA. defelikm@ucmail.uc.edu.

Abstract

Purpose of review: Treatment of inflammatory bowel disease (IBD) in the elderly requires special attention to treatment efficacy while considering drug safety, other medical comorbidities, and the patients' risk for treatment related adverse events. In this article, we reviewed the indications and safety of the newer IBD therapies in the older IBD patient beyond anti-TNF agents, thiopurines, and corticosteroids.

Recent findings: Vedolizumab, ustekinumab, and risankizumab have favorable side effect profiles with regards to infections and malignancy. Ozanimod has a favorable side effect profile with regards to infection and malignancy, however cardiac events and macular edema are potential risks. Tofacitinib and upadacitinib are associated with an increased risk of serious infections, herpes zoster, malignancy, and have potential for an increased risk of cardiac events and thrombosis. From a safety profile perspective, vedolizumab, ustekinumab, and risankizumab should be considered first line treatment options for moderate-to-severe IBD in the elderly. Risk-benefit discussions are indicated for ozanimod, tofacitinib, and upadacitinib.